THE  PROCEEDINGS 

OF  THE 

QUARANTINE  CONFERENCE 

HELD  IN  MONTGOMERY,  ALA., 

On  the  5th,  6th,  and  7th  days  of  March,  1889. 


The  Brown  Printing  Company,  Montgomery,  Ala. 


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PREFACE. 


By  way  of  preface  to  the  Proceedings  of  the  Montgomery 
Quarantine  Conference  herewith  published,  I  desire  to  say  that 
I  have  printed  said  Proceedings  just  as  they  came  to  me,  from 
the  Editing  Committee.  It  is,  however,  proper  for  me  to 
state  that  the  discussions  given  in  the  text  have  been  clipped 
from  the  reports  of  the  daily  papers.  While  they  are  approxi¬ 
mately  correct,  they  are  not  usually  adequate  reproductions  of 
the  remarks  that  were  actually  made  by  the  several  speakers. 

The  subjoined  circular  letter  explains,  perhaps,  at  sufficient 
length,  how  and  under  what  circumstances  the  Conference  had 
its  origin. 

Jerome  Cochran,  M.  D., 

State  Health  Officer. 

Montgomery,  April  10th,  1889. 


QUARANTINE  CONFERENCE. 


CIRCULAR  LETTER. 


This  Circular  Letter  is  specially  addressed  to  the  health  authorities 
of  the  several  States  most  directly  interested  in  the  protection  of  the 
South  against  invasions  of  yellow  fever.  Copies  of  it  will  also  be  sent 
to  the  Governors  of  the  several  States  referred  to,  and  to  the  Mayors  of 
some  of  the  more  important  cities  for  their  information,  and  with  a  view 
of  enlisting  intelligent  interest  in  the  undertaking  herein  explained. 

Under  a  joint  resolution  of  our  General  Assembly,  the  Governor  of 
the  State  of  Alabama  has  issued  to  the  Governors  of  the  States  of  Texas, 
Florida,  Louisiana,  Mi  sissippi,  South  Carolina,  North  Carolina,  Geor¬ 
gia,  Tenn  *s-5  *e,  Kentucky,  a  id  Illinois,  invitations  to  appoint  delegates 
to  a  Quarantine  Conference  to  be  held  in  the  city  of  Montgomery,  be¬ 
ginning  on  lu  sd  ly  the  5th  of  March,  next,  and  to  continue  for  such 
number  of  days  as  the  business  in  hand  may  render  necessary. 


4 


About  two  weeks  ago  Dr.  C.  P.  Wilkinson,  President  of  the  Board  of 
Healtli  of  the  State  of  Louisiana,  addressed  a  Circular  Letter  to  the 
health  authorities  of  these  same  States,  suggesting  a  similar  conference 
to  be  held  in  the  city  of  Jacksonville,  Florida.  I  have  been  in  corres¬ 
pondence  with  Dr.  Wilkinson,  and  the  assemblage  of  the  pro-posed 
Conference  in  Montgomery  meets  with  his  approval. 

The  object  of  the  Conference  cannot  be  easily  overrated.  It  is  to 
formulate  in  a  way  that  will  command  the  confidence  of  the  general 
public  and  of  the  civil  and  sanitary  authorities  of  the  States  concerned, 
and  in  the  light  of  our  latest  experience  and  information,  the  princi¬ 
ples  and  regulations  which  should  govern  our  Southern  Quarantines, 
and  at  the  same  time  to  arrange  such  plans  for  harmony  and  concert 
of  action  as  may  seem  praticable  and  desirable. 

It  is  earnestly  desired  that  all  of  the  States  included  in  the  invita¬ 
tion  shall  be  represented  in  the  Conference  by  full  delegations  of  such 
of  their  citizens  as  are  best  fitted  to  discuss  the  theoretical  and  practi¬ 
cal  problems  involved  in  the  rational  administration  of  quarantine  in 
the  South.  The  occasion  ought  to  be  made  a  very  memorable  one. 

The  Conference  proper  will  be  composed  exclusively  of  the  duly 
accredited  delegates  of  the  States ;  but  other  persons  interested  in 
quarantine  matters  will  be  heartily  welcomed  to  seats  on  the  floor,  and 
to  take  such  part  in  the  discussions  as  under  the  circumstances  may 
seem  expedient. 

To  facilitate  the  work  of  the  Conference,  experts  believed  to  be 
specially  qualified,  will  be  requested  to  formulate  in  advance  for  dis¬ 
cussion,  a  series  of  propositions  covering  the  subjects  of  maritime 
quarantine,  railroad  quarantine,  municipal  quarantine,  depopulation  of 
infected  towns,  refugee  camps,  panics,  stampedes,  disinfection,  health 
certificates,  etc. 

We  desire  the  assistance  and  co-operation  of  all  who  have  had  ex¬ 
perience  in  the  management  of  quarantines,  and  of  all  who  have  studied 
the  progress  of  epidemics  of  yellow  fever.  Suggestions  through  the 
mails  will  be  thankfully  received. 

All  persons  receiving  this  Circular  Letter  will  confer  a  favor  by 
acknowledging  its  reception,  and  notifying  us  what  themselves  and 
the  communities  they  represent  can  be  depended  on  to  contribute  to 
the  success  of  the  Conference. 

Address  all  communications  to 

JEROME  COCHRAN,  M.  D., 

State  Health  Officer. 

Montgomery,  Ala.,  January  10th,  1889. 


PROCEEDINGS  OF  THE  QUARANTINE  CON¬ 
FERENCE  HELD  IN  THE  CITY  OF 
MONTGOMERY,  ALABAMA, 

March  5th,  6th  and  7th,  1889. 


The  Quarantine  Conference  met  in  the  hall  of  the  house  of 
representatives  at  the  capitol  at  10  o’clock  a.  m.,  March 
5th,  1889. 

The  Conference  was  called  to  order  by  Dr.  Jerome  Cochran, 
State  Health  Officer  of  Alabama,  and  the  meeting  opened  with 
prayer  by  Rev.  J.  L.  Thompson,  of  the  Adams  Street  Baptist 
Church,  Montgomery. 

Dr.  Cochran  addressed  the  Conference  briefly,  stating  that 
he  had  expected  Governor  Seay  to  be  present  and  deliver  an 
address  of  welcome.  He  had  been  informed  that  the  governor 
was  unwell  and  not  able  to  be  present.  Dr.  Cochran  assured 
the  delegates  that  Montgomery  was  glad  to  have  them  in  her 
borders,  and  that  they  would  meet  a  warm  and  generous  wel¬ 
come  among  her  people.  He  stated  that  the  work  to  be  done 
by  the  Conference  would  be  of  great  importance  to  all  the 
southern  states.  Lie  wanted  the  Conference  to  cover  the 
ground  and  complete  the  discussion  whether  it  took  three  days 
or  a  week. 

Dr.  Cochran  then  nominated  Dr.  John  H.  Rauch,  of  Illinois, 
for  temporary  president  of  the  Conference,  and  Dr.  E.  J. 
Conyngton,  of  Decatur,  Alabama,  for  temporary  secretary. 
He  put  the  motion  and  they  were  unanimously  chosen  as  tem¬ 
porary  officers. 

On  taking  the  chair  Dr.  Rauch  stated  that  the  Conference 
was  ready  for  business,  and  inquired  the  will  of  the  body. 

Dr.  P.  Thompson,  of  Kentucky,  moved  that  a  committee  of 
five  (5)  be  appointed  on  permanent  organization.  The  motion 
prevailed,  and  the  committee  was  appointed  by  the  chair  as 
follows,  viz ; 


6 


Dr.  P.  Thompson,  of  Kentucky,  Dr.  R.  P.  Daniel,  of  Florida, 
Dr.  Thos.  F.  Wood,  of  North  Carolina,  Dr.  J.  D.  Plunket,  of 
Tennessee,  and  Dr.  Jerome  Cochran,  of  Alabama. 

Upon  motion  of  Dr.  Cochran,  the  Conference  took  a  recess 
until  11  o’clock  to  enable  the  committee  to  fermulate  their 
report. 

At  11  o’clock  the  Conference  was  called  to  order  by  Dr. 
Rauch,  and  heard  the  following  report  from  the  committee  on 
permanent  organization  : 

MINUTES  OF  COMMITTEE  ON  PERMANENT  ORGANIZATION. 

Your  committee  beg  leave  to  report  the  following  gentlemen 
as  accredited  delegates  to  the  Southern  Quarantine  Conference, 
viz : 

Roll  of  Delegates  of  the  Southern  Quarantine  Conference 
held  in  the  city  of  Montgomery,  Alabama,  on  the 
5th  and  6th,  and  7th  of  March,  1889  : 

Alabama  : — 

Mr.  Theodore  Welch,  general  transportation  agent,  L.  &  N. 
R.  R.,  Montgomery. 

Mr.  B.  C.  Epperson,  superintendent  M.  &  M.  R.  R., 
Montgomery. 

Col.  W.  S.  Reese,  mayor,  Montgomery. 

Dr.  Jerome  Cochran,  Montgomery. 

Dr.  S.  D.  Seelye,  member  state  board  of  health,  Mont¬ 
gomery. 

Dr.  J.  S.  Weatherly,  member  state  board  of  health,  Mont¬ 
gomery. 

Dr.  T.  A.  Means,  secretary  state  board  of  health,  Mont¬ 
gomery. 

Col.  J.  C.  Clarke,  Mobile,  vice-president  M.  &  O.  R.  R. 

Dr.  C.  H  .Franklin,  member  state  board  of  health,  Union 
Springs. 

Dr.  W.  II.  H.  Flutton,  U.  S.  M.  II.  S.,  Mobile. 

Dr.  John  B.  Hamilton,  U.  S.  M.  IT.  S.,  Surgeon  General  Ma¬ 
rine  Hospital  Service. 


7 


Florida  : — 

Dr.  Richard  P.  Daniel,  Jacksonville. 

Dr.  J.  T.  Porter,  Key  West. 

Dr.  J.  D.  Palmer,  Fernandina. 

Dr.  J.  P.  Wall,  Tampa. 

Dr.  W.  H.  Foss,  Pensacola.  . 

Dr.  T.  J.  Williamson. 

Mr.  Joseph  Voyle,  Gainesville. 

Mr.  J.  E.  Ingraham,  Sanford. 

Mr.  Wm,  B.  Henderson,  Tampa. 

Mr.  W.  K.  Hyer,  Pensacola. 

Georgia  : — 

Dr.  J.  B.  S.  Holmes,  Fome. 

Dr.  S.  C.  Benedict,  Athens. 

Dr.  James  B.  Baird,  Atlanta. 

Dr.  W.  D.  Bizzell,  Atlanta. 

Dr.  J.  McF.  Gaston,  Atlanta. 

Dr.  E.  Burkley,  Atlanta. 

Dr.  J.  A.  Dunwoody,  Brunswick. 

Dr.  W.  B.  Burroughs,  Brunswick. 

Dr.  Eugene  Foster,  Augusta. 

Dr.  J.  C.  L.  Hardy,  Savannah. 

Dr.  E.  G.  Ferguson,  Macon. 

Mr.  E.  T.  Charlton,  Savannah, 

Illinois  : — 

Dr.  John  H.  Fauch,  secretary  state  board  of  health. 
Dr.  B.  F.  Griffith. 

Dr.  F.  E.  Starkweather. 

Kentucky  : — 

Dr.  J.  H.  McCormick,  secretary  state  board  of  health. 
Dr.  P.  Thompson,  president  state  board  of  health. 

Dr.  Wm.  Bailey,  member  state  board  of  health. 

Dr.  J.  O.  McFeynolds. 


8 


Louisana  : — 

Mr.  B.  R.  Freeman,  New  Orleans. 

Dr.  J.  W.  Dupree,  Baton  Rouge. 

Dr.  C.  M.  Smith,  Franklin. 

Dr.  Robert  Layton,  Monroe. 

Dr.  W.  G.  Austin,  New  Orleans. 

Dr.  Clement  P.  Wilkinson,  president  state  board  of  health. 
North  Carolina  : — 

Dr.  Thomas  F.  Wood,  secretary  state  board  of  health,  Wil¬ 
mington. 

Dr.  R.  F.  Gray,  Winston. 

Dr.  T.  A.  Allen,  Hendersonville. 

Dr.  Joseph  F.  Harrell,  Whiteville. 

Mr.  J.  L.  Ludlow,  C.  E.,  member  state  board  of  health, 
Winston. 

Mr.  Joseph  E.  Robinson,  Goldsboro. 

Mr.  James  Norfleet,  Henderson. 

Mississippi  : — 

Dr.  J.  M.  Taylor,  Corinth. 

Dr.  R.  S.  Toombs,  Greenville. 

Dr.  G.  W.  Trimble,  Grenada. 

Dr.  W.  F.  Hyer,  Meridian. 

Dr.  O.  R.  Early,  Columbus. 

South  Carolina: — 

Dr.  T.  Grange  Simons,  Charleston. 

Dr.  H.  B.  Horlbeck. 

Tennessee  : — 

Dr.  J.  D.  Plunket,  president  state  board  of  health. 

Dr.  G.  B.  Thornton,  Memphis. 

Dr.  John  E.  Black,  president  Memphis  board  of  health. 
Hon.  R.  P,  Hadden,  Memphis. 


9 


Texas  : — 

Dr.  Robert  Rutherford,  state  health  officer. 
Dr.  L.  A.  Pires. 


Visiting  Guests. 

Dr.  Victor  M.  Vaughn,  Michigan. 

Dr.  George  M.  Sternberg,  U.  S.  A.,  Baltimore,  Maryland. 

Dr.  D.  M.  Burgess,  U.  S.  sanitary  inspector,  Havana. 

Dr.  T.  C.  VanBibber,  Baltimore,  Maryland. 

We  also  beg  leave  to  report  the  following  recommendation 
for  permanent  officers : 

For  President — Dr.  C.  P.  Wilkinson,  Louisana. 

For  Vice-Presidents — Hon.  David  P.  Haddon,  Tennessee, 
Dr.  T.  Grange  Simons,  South  Carolina,  Mr.  E.  Berkeley, 
Georgia,  Dr.  William  Bailey,  Kentucky,  Mr.  J.  C.  Clark, 
Alabama,  Dr.  Robert  Rutherford,  Texas,  Dr.  J.  Y.  Porter, 
Florida,  Dr.  R.  F.  Gray,  North  Carolina,  Dr.  B.  M.  Griffith, 
Illinois,  Dr.  J.  M.  Taylor,  Mississippi. 

Secretaries — Dr.  J.  N.  McCormack,  Kentucky,  Mr.  J.  L. 
Ludlow,  C.  E.,  North  Carolina,  Dr.  J.  B.  Baird,  Georgia. 

RULES  OF  ORDER. 

1.  Each  state  shall  be  allowed  ten  votes,  whenever  a  divis¬ 
ion  is  asked  on  any  pending  motion,  said  votes  to  be  divided  ac¬ 
cording  to  the  pleasure  of  the  delegation,  and  to  be  announced 
by  the  chairman  of  the  delegation. 

2.  Where  no  division  is  asked  for  the  votes  shall  be  by 
ayes  and  noes. 

3.  In  all  discussions  each  speaker  shall  be  limited  to  ten 
minutes. 

We  recommend  that  all  visiting  gentlemen  who  do  not  come 
accredited  by  certificates  of  delegation  from  Governors  of  their 
states,  but  who  are  specially  interested  in  the  purposes  of  the 
call  of  this  Conference,  be  invited  to  participate  in  all  the  privi¬ 
leges  of  this  body,  except  that  of  voting. 


10 


Order  of  Discussion  of  Subjects : 

Maritime  Quarantine . 

The  papers  of  Dr.  D.  N.  Burgess,  U.  S.  Sanitary  Inspector 
at  Havana. 

And  Dr.  Wilkinson,  President  Louisiana  Board  of  Health. 

Inland  Quarantine. 

Bail  Boad  Quarantine. 

Local  Management  of  Epidemics. 

The  report  of  the  committee  was  unanimously  adopted. 

On  motion,  a  committee  of  two  was  appointed  to  conduct 
Dr.  Wilkinson,  the  permanent  President,  to  the  chair.  On 
taking  the  chair  Dr.  Wilkinson  expressed  sincere  thanks  to  the 
Conference  for  the  honor  conferred  in  making  him  President, 
which  he  took  as  a  compliment  to  the  State  Board  of  Health 
of  Louisiana,  rather  than  a  personal  honor.  His  thanks  were 
tendered  in  behalf  of  his  colleagues,  who  were  marching  hand 
in  hand  with  the  gentlemen  who  composed  the  Conference,  for 
the  cause  of  quarantine  and  sanitary  improvement. 

On  motion  of  Dr.  Cochran,  Gov.  Seay,  who  had  arrived  and 
was  present  in  the  hall,  was  invited  to  address  the  Conference. 
The  Governor  was  escorted  to  the  Speaker’s  stand  and  spoke 
as  follows  : 


THE  GOVERNOR’S  SPEECH. 

Mr.  President  and  Gentlemen  of  the  Convention  : 

It  would  be  an  intrusion  on  your  consecrated  time  to  offer  more  than 
a  few  words  of  welcome. 

You  are  here  formally  in  answer  to  an  invitation  of  the  authorities 
of  this  State,  but  really  in  response  to  the  profound  invocation  of  hu¬ 
manity. 

Pestilence  has  always  been  the  great  enemy  of  mankind,  and  the 
most  favored  nations  have  not  been  exempt  from  its  havoc.  Science 
and  government  have  done  much,  very  much,  to  diminish  its  ravages, 
and  I  do  not  doubt  that  they  will  yet  be  sufficient  to  destroy  it  alto¬ 
gether.  The  last  great  enemy  is  death,  and  if  it  shall  coine  under  the 
foot  of  man,  the  honor  will  lie  at  the  feet  of  science. 


11 


Again,  gentlemen,  I  acknowledge  my  own  pleasure  in  welcoming  you 
to  this  place  and  invoking  success  on  your  councils. 

Dr.  T.  Grange  Simons  was  called  to  the  chair,  and  Dr.  L.  P. 
Wilkinson,  the  President,  read  the  following  paper  on  “Mari¬ 
time  Quarantine  Services  of  the  Southern  Sea  Ports.”  [See 
Appendix  II.] 

Upon  motion,  the  paper  of  Dr.  Wilkinson  was  received  by 
v  the  Conference,  to  be  referred  to  an  appropriate  committee  to 
be  appointed. 

Upon  motion  of  Mr.  B.  R.  Foreman,  the  Chair  appointed  a 
Committee  on  Business,  consisting  of  one  member  from  each 
state  represented  and  one  each  from  the  U.  S.  A.  and  the  U. 
S.  M.  II.  S.j  to  whom  all  papers,  propositions  and  resolutions 
shall  be  presented,  and  who  shall  prepare  a  program  of  order 
of  business. 

The  committee  was  named  by  the  Chair  as  follows,  viz: 

Alabama . Dr.  Jerome  Cochran, 

Florida . Dr.  R.  P.  Daniel, 

Georgia . Dr.  W.  D.  Bizzell, 

Kentucky . Dr.  J.  D.  McRevnolds, 

Louisiana . Dr.  J.  W.  DuPoe, 

Mississippi . Dr.  R.  S.  Toombs, 

North  Carolina.  . .  .Dr.  Thos.  F.  Wood, 

South  Carolina . Dr.  T.  Grange  Simons, 

Tennessee . Dr.  J.  D.  Plunkett, 

Texas . Dr.  R.  Rutherford, 

U.  S.  A . Dr.  G.  M.  Sternberg, 

U.  S.  M.  H.  S . Surg.  Gen.  J.  B.  Hamilton. 

\  Illinois . 

Note. — After  one  meeting  of  this  committee,  Dr.  Cochran  declined  to 
,  serve  on  it  any  longer ;  and  his  place  was  taken  by  Dr.  M.  C.  Baldridge, 

President  of  the  Alabama  State  Board  of  Plealth. 

Adjourned. 


12 


AFTERNOON  SESSION.  FIRST  DAY. 

Called  to  order  by  President  Wilkinson  at  3  p.  m.  Report 
of  Committee  on  Easiness  was  presented  by  Dr.  Thomas  F. 
Wood  of  N.  C.,  as  follows: 

COMMITTEE  ON  BUSINESS 

beg  leave  to  submit  the  following  : 

Hours  of  meeting  from  10  to  1.30  a.  m.  ;  3.30  to  6  p.  m.  ; 
8  to  10  p.  m. 

Order  of  Business. 

1.  Reading  Minutes. 

2.  Reports  of  Committees. 

3.  Reading  of  Papers. 

4.  Discussion  of  Papers. 

5.  Unfinished  Business. 

The  following  papers  ordered  for  Afternoon  Session,  5th 
March  : 

Paper  by  Mr.  J.  C.  Clarke,  Y.  P.  M.  &  O.  R.  R.,  on  “Rail¬ 
way  Quarantine.” 

One  by  Dr.  YanBibber,  on  “Quarantine  of  the  Future.” 

One  by  Mr.  Yoyle,  on  the  “Epidemic  of  Yellow  Fever  in 
Gainesville,  Fla.,  and  the  Deducions  therefrom. 

The  report  was  adopted. 

Dr.  G.  B.  Thornton  of  Tenn.  read  the  following  paper,  by 
Col.  J.  C.  Clarke  of  the  Mobile  &  Ohio  R.  R.,  on  Rail  Road 
Quarantine.  [For  paper,  see  Appendix  III.] 

By  motion,  the  paper  was  received  and  referred  to  a  Com¬ 
mittee  on  Quarantine  to  be  provided. 

Upon  motion  of  Dr.  Eugene  Foster  (Ga.),  a  committee  was 
appointed  by  the  Chair,  consisting  of  one  delegate  from  each 
of  the  States  represented,  and  the  U.  S.  M.  H.  S.,  to  whom  all 
papers  relating  to  Quarantine  and  all  propositions  relating 
thereto,  should  be  referred. 


13 


Committee  named  by  the  Chair  as  follows,  viz : 


Alabama . Dr.  E.  J.  Conyngton, 

Florida . .Dr.  J.  P.  Wall, 

Georgia . Dr.  Eugene  Foster, 

Illinois . Dr.  B.  M.  Griffith, 

Kentucky . Dr.  P.  Thompson, 

Louisiana . Dr.  C.  M.  Smith, 

Maryland . Dr.  W.  C.  Yan  Bibber, 

Mississippi . Dr.  W.  F.  Hyer, 

North  Carolina . Dr.  Thomas  F.  Wood, 

South  Carolina . Dr.  II.  B.  Horlbeck, 

Tennessee . Dr.  G.  B.  Thornton, 

Texas . Dr.  L.  A.  Pires, 

U.  S.  M.  H.  S . Dr.  W.  H.  H.  Hutton. 

The  next  business  of  the  Conference  was  the  reading  of  the 


paper  by  Mr.  Joseph  Yoyle  of  Fla.,  on  the  “Epidemic  of  Yel¬ 
low  Fever  at  Gainesville,  Fla.,  and  the  Deductions  therefrom.” 
[For  paper,  see  Appendix  IY.] 

Conference  adjourned. 


NIGHT  SESSION.  FIRST  DAY. 

Called  to  order  by  President  Wilkinson  at  8.30  p.  m.  The 
Committee  on  Business  presented  its  report  by  a  series  of  topics 
for  discussion. 

Upon  motion  of  Dr.  Wood  (N.  C.),  the  topics  were  read  and 
discussed  singly. 

Topic  I.  What  form  of  notification  shall  be  adopted  in  case 
of  occurrence  of  yellow  fever?  To  whom  shall  the  first  noti¬ 
fication  be  sent  ? 

Dr.  Thompson  said  that  a  conference  which  met  at  Memphis 
in  1878  formulated  a  set  of  rules  which  ought  to  be  adopted 
all  around.  By  this  set  of  rules  it  was  the  duty  of  every  health 


14 


officer  to  notify  the  State  health  officer  and  the  local  officers. 

He  thought  that  when  a  case  of  fever  appeared  at  any  one 
place,  every  place  in  the  State  or  in  the  section  ought  to  know 
it  as  quick  as  lightning. 

Hr.  McCormack  of  Kentucky  explained  that  at  a  quarantine 
conference  held  at  Toronto  some  time  ago,  the  health  officers  ^ 

of  all  the  State  health  boards  in  the  Union  had  agreed  to  a 
blank  form  of  notification  to  be  sent  to  every  other  health  offi¬ 
cer,  and  he  knew  of  no  single  instance  where  the  pledge  or 
agreement  had  been  violated.  The  pledges  extended  to  small¬ 
pox  and  every  contagious  or  infectious  disease. 

Hr.  Wilkinson  said  the  question  of  notifying  health  boards 
wras  a  serious  question,  and  one  that  ought  not  to  create  unnec¬ 
essary  alarm.  ITe  was  opposed  to  notifying  anybody  except 
officers  of  the  health  boards  of  occurrence  of  a  case  or  suspi¬ 
cious  case  of  any  disease  included  in  the  resolution. 

Hr.  Simons  thought  the  United  States  Marine  Hospital  Ser¬ 
vice  ought  to  be  included  in  the  resolution,  and  made  a  motion 

to  that  effect. 

The  resolution  was  carried.* 

Hr.  Thornton — A  number  of  members  of  boards  of  health 
now  here  are  already  pledged,  in  honor  bound,  by  the  rules 
of  quarantine  conferences  of  1879  and  1884,  to  notify  each 
other  whenever  a  case,  not  only  of  yellow  fever,  but  even  a 
suspicious  case  occurs.  He  thought  every  health  officer  in 
this  country  and  in  Canada  should  be  officially  notified,  for  it 
was  an  international  affair.  Hr.  Holt,  of  Hew  Orleans,  and 
Hr.  Wirt  Johnson,  of  Mississippi,  had  both  given  notice  offi¬ 
cially  whenever  cases  of  fever  or  suspicious  cases  had  appeared 
in  their  fields  and  come  to  their  notice.  He  thought  notice, 
official  notice  of  occurrence  of  cases  or  suspicious  cases,  ought 
to  be  sent  to  everybody  interested.  The  question  arose  as  to 
whether  the  notification  ought  to  be  sent  by  open  or  cipher 
telegram,  and  he  was  of  the  opinion  that  open  telegrams  ought 
to  be  sent. 

Upon  motion  of  Hr.  Cochran,  the  following  was  adopted 
as  the  sense  of  Conference  in  answer  to  Topic  I: 


*No  resolution  in  copy. 


15 


Resolved ,  That  this  Convention  urges  upon  all  health  au¬ 
thorities  of  States  represented  in  it  the  importance  of  strict  com¬ 
pliance  with  the  agreement  of  inter-state  notification  adopted 
by  the  National  Conference  of  State  Boards  of  Health ,  and 
the  Sanitary  Council  of  the  Mississippi  Valley ,  in  regard  to 
all  communicable  diseases ,  and  especially  in  regard  to  yellow 
fever. 


Topic  2.  Under  what  circumstances  should  an  epidemic  be 
declared  to  exist  \ 

Dr.  Thompson  said  that  the  question  had  been  asked  many 
a  time,  and  no  satisfactory  answer  had  ever  been  given.  The 
universally  adopted  thought  was  that  when  a  number  of  deaths 
occurred  in  any  town  from  one  disease,  or  a  large  number  had 
been  taken  sick,  that  was  an  epidemic. 

Dr.  Thornton  stated  that  he  once  had  an  occasion  to  decide 
this  question  of  when  an  epidemic  existed.  During  the  snm- 
,  mer  of  1878,  when  the  fever  appeared  in  Memphis,  there  was 
a  considerable  number  of  cases  before  he  was  inclined  to 
believe  it  was  epidemic.  He  had  never  officially  announced  to 
the  world  that  yellow  fever  was  epidemic  until  deaths  from 
that  disease  were  more  than  from  all  other  diseases. 

The  question  was,  on  motion  of  Dr.  Rauch,  laid  on  the 
table. 


Topic  3.  Should  we  advise  the  depopulation  of  any  place 
on  the  appearance  of  yellow  fever,  and  if  so,  how  soon  ? 

Dr.  Thornton  was  opposed  to  depopulation. 

Dr.  Cochran  would  not  advise  depopulation  on  the  occur¬ 
rence  of  one  case  or  even  of  a  dozen  cases.  If  a  case  appeared 
in  a  portion  of  a  town  he  would  advise  the  depopulation  of  the 
adjacent  houses  and  districts,  but  he  was  opposed  to  depopu¬ 
lating  whole  towns  and  cities,  for  such  a  course  resulted  in 
panic  and  stampedes  and  this  Conference  ought  to  rebuke  this 
course  severely.  When  the  yellow  fever  overstepped  all 
bounds  it  would  be  time  to  talk  of  depopulating  towns,  but 


16 


he  believed  the  fever  ccmld  be  kept  in  bounds  and  had  no 
business  ever  getting  out. 

Dr.  Wood  thought  the  Conference  ought  to  say  distinctly 
when  it  was  advisable  for  depopulation  to  commence.  He 
had  no  idea  but  that  every  physician  in  the  Conference  would 
advise  some  patients  to  get  out  in  time  of  yellow  fever. 

Dr.  Hyer  said  that  there  need  be  no  trouble  about  advising 
a  man  to  get  out  of  town  in  time  of  yellow  fever,  for  when 
you  went  to  tell  him  he  wouldn’t  be  there  unless  all  the  wagons 
had  gone  before.  The  trouble  was  in  getting  people  to  stay. 

Dr.  Cochran  said  this  thing  of  depopulating  whole  towns 
when  a  few  cases  appeared,  brought  great  mischief.  He  be¬ 
lieved  the  time  was  coming  when  yellow  fever  would  be  so 
completely  under  the  control  of  physicians  that  when  a  special 
house  or  district  was  infected  the  people  would  not  rebel. 

Dr.  Thornton  moved  to  refer  the  question  of  depopulation 
to  the  people  of  the  towns  interested. 

Mr.  Yoyle  said  depopulation  had  bankrupted  Gainesville, 
Fla.  The  people  ought  to  be  educated  to  take  care  of 
themselves,  until  this  question  could  be  settled.  He  described 
all  the  terrors  that  existed  there  during  the  epidemic  of  last 
summer. 

Dr.  Sternberg  said  depopulation  was  one  thing  and  a 
stampede  was  another.  The  first  thing  to  be  done  in  an  in¬ 
fected  locality  was  to  remove  well  people  from  infected  dis¬ 
tricts  so  as  to  keep  them  from  exposure.  He  thought  the 
Conference  ought  to  adopt  a  resolution  that  depopulation  of 
infected  areas  by  health  officers  was  an  important  step  in  check¬ 
ing  the  progress  of  the  disease  and  made  a  motion  to  that 
effect. 

Dr.  Hamilton  seconded  Dr.  Sternberg’s  motion,  and  gave 
the  history  of  several  cases  of  yellow  fever  cases  in  Baltimore 
in  1886,  when  the  whole  city  was  spared  an  epidemic  by  the 
depopulation  of  a  block. 

Dr.  Cochran  said  that  the  Conference  was  disposing  of  a 
very  important  question  in  a  short  time.  The  following 
propositions  covered  the  question  : 


t 


17 

(1)  In  the  beginning  of  an  outbreak  of  yellow  fever  there  is  no  need 
of  depopulation  at  all  except  of  infected  houses  or  infected  districts ; 
but  if  people  who  are  able  to  afford  the  expense  desire  to  leave  they 
should  do  so  quietly  and  deliberately,  and  no  obstacles  should  be  placed 
in  their  way ;  and  those  who  leave  healthy  districts  of  the  city  or  town 
should  go  wherever  J:hey  please  without  let  or  hindrance. 

(2)  Persons  living  in  infected  houses  or  in  infected  districts,  should 
be  encouraged  to  leave,  but  should  be  allowed  to  leave  only  under  such 
restrictions  as  will  afford  reasonable  guarantee  of  safety  to  the  communi¬ 
ties  in  which  they  find  asylum;  and  they  should  be  sent  only  to  such 
communities  as  are  willing  to  receive  them. 

(3)  In  the  depopulation  of  infected  houses  or  of  special  infected  dis¬ 
tricts  the  inhabitants  should  be  removed  into  camps  of  probation,  or 
into  vacant  houses  in  the  adjacent  country.  After  five  days  detention 
if  they  remain  well,  and  under  proper  regulations,  such  as  disinfection 
of  baggage,  they  should  be  considered  free  from  danger,  and  allowed 
to  go  freely  into  any  community  willing  to  receive  them. 

(4)  The  depopulation  of  large  cities  is  altogether  impracticable.  The 
depopulation  of  sparsely  settled  towns  and  villages  is  altogether  unnec¬ 
essary,' as  in  them  it  is  always  possible  to  prevent  any  general  spread 
of  the  fever. 

(5)  Refuge  camps,  that  is  to  say  camps  for  the  continued  residence 

* 

of  people  during  the  prevalence  of  epidemics,  have  heretofore  been  of 
very  small  value.  One  reason  for  this  is,  that  it  is  never  possible  to 
induce  any  considerable  proportion  of  the  population  of  an  infected 
city  to  take  refuge  in  the  camps.  Camps  of  probation  for  temporary 
detention,  may  often  be  very  useful. 

(6)  Panics  and  stampedes  are  always  without  excuse  and  at  the  same 
time  excessively  mischievous.  At  the  beginning  yellow  fever  always 
spreads  slowly,  and  there  is  always  time  for  everybody  who  desires  to 
leave  an  infected  place  to  do  so  without  hurry  and  under  proper  regula¬ 
tions. 

Dr.  Weatherly  thought  Dr.  Cochran  was  eminently  right. 
Dr.  Thompson  said  that  Dr.  Sternberg’s  resolution  was  a 
very  good  thing  in  theory,  and  was  doubtless  drawn  under  the 
impression  that  the  health  officers  had  powers  to  depopulate 
towns.  If  there  was  a  place  in  the  country  where  such  power 
existed  he  had  never  heard  of  it.  There  was  no  power  on 
earth  to  make  a  man  get  out  of  his  own  house  when  he  did 
not  want  to.  You  could  make  him  stay  in,  but  when  it  came 
to  making  him  get  out  that  was  a  different  thing. 

2 


Dr.  Seelye  said  the  resolutions  would  be  interpreted  by 
health  boards  very  indefinitely,  and  offered  as  a  supplement  ta 
Dr.  Sternberg’s  resolution  the  first  three  propositions  submitted 
by  Dr.  Cochran. 

Dr.  Sternberg  accepted  the  suggestion  of  Dr.  Seelye  as  a 
substitute  for  his  motion. 

Dr.  Bailey  thought  the  putting  of  people  in  camps  of  de¬ 
tention  and  keeping  them  there  five  days  was  unwise.  Com¬ 
ing  from  a  section  that  had  shown  it  was  anxious  to  welcome 
refugees  he  would  much  rather  have  refugees  who  stood  not 
on  the  order  of  their  going.  lie  thought  depopulation  in 
cases  of  yellow  fever  was  wise  and  practicable.  Yellow  fever 
was  the  best  thing  in  the  world  to  run  from. 

Dr.  Cochran  did  not  think  any  prudent  people  would  care 
to  have  people  taken  out  of  infected  houses  or  squares  amongst 
them.  As  to  refugee  camps,  people  generally  would  not  go  to 
them,  never  had  gone  to  them  and  could  never  be  expected  to 
go  to  them. 

Dr.  Horlbeck  thought  the  time  of  probation  ought  to  be  ten 
instead  of  five,  and  a  motion  was  made  to  that  effect.  Carried. 

Dr.  Rutherford  said  he  could  not  leave  the  time  of  proba¬ 
tion  five  days;  he  could  not  go  back  to  Texas  if  he  voted  for 
that  proposition. 

Dr.  Cochran  said  we  were  not  here  to  represent  the  views  of 
our  constituents  like  members  of  a  legislature;  our  mission 
here  was  to  give  the  people  the  benefits  of  scientific  researches 
which  would  control  legislation  and  public  opinion. 

The  following  resolutions  offered  by  Dr.  Seelye  were  then 
adopted  as  the  sense  of  the  Conference  as  the  answer  to 
Topic  3  : 

Resolved ,  In  the  beginning  of  an  outbreak  of  yellow  fever 
there  is  no  need  of  depopulation  at  all ,  except  of  infected  houses , 
or  infected  districts',  but  if  people  who  are  able  to  afford  the  ex¬ 
pense  desire  to  leave  they  should  do  so  quietly  and  deliberately , 
and  no  obstacles  shoidd  be  placed  in  their  way  /  and  those  who 
leave  healthy  districts  of  the  city  or  town  shoidd  go  wherever 
they  please,  without  let  or  hindrance. 


19 


(ff)  Persons  living  in  infected  houses ,  or  in  infected  districts 
shoidd  he  encouraged  to  leave ,  should  he  allowed  to  leave 

only  under  such  restrictions  as  will  afford  reasonable  guaran¬ 
tees  of  safety  to  the  communities  in  which  they  find  asylum  / 
and  they  should  he  sent  only  to  such  communities  as  are  willing 
to  receive  them. 

(3)  In  the  depopulation  of  infected  houses  or  of  special  in¬ 
fected  districts ,  the  inhabitants  shoidd  he  removed  into  camps 
of  probation,  or  into  vacant  houses  in  the  adjacent  country. 
After  ten  days  detention ,  if  they  remain  well ,  and  under  proper 
regulations ,  such  as  disinfection  of  baggage ,  they  should  he  con¬ 
sidered  free  from  danger ,  and  allowed  to  go  freely  into  any 
community  willing  to  receive  them. 

Conference  adjourned. 


MOKNING  SESSION— SECOND  DAY. 

Called  to  order  by  President  Wilkinson  at  10  a.  m.  The 
committee  on  quarantine  presented  its  report  through  its  chair¬ 
man,  Dr.  Eugene  Foster,  of  Georgia. 

Upon  motion,  the  report  was  read  and  discussed,  section  by 
section, ’as  follows  : 

Your  committee  respectfully  report  the  following  in  rela¬ 
tion  to  the  paper  of  Mr.  Clark  : 

That  section  I  should  read — 

There  should  be  uniform  rules  adopted  for  the  management  of  quar¬ 
antines  as  far  as  practical,  but  no  freight  shall  be  received  from  an.  in¬ 
fected  place,  though  freight  and  passengers  should  be  allowed  to  pass 
through  an  infected  place  without  stopping. 

Upon  motion  of  Dr.  Cochran,  the  following  resolutions 
were  adopted  as  the  sense  of  the  Conference  in  lieu  of  Section 
(1)  above : 

Resolved,  During  the  prevalence  of  yellow  fever  epidem  ics, 
passengers  and  freights  should  he  brought  from  infected  local- 


20 


ities  only  under  such  regulations  and  restrictions  as  may  he 
established  by  the  state  health  authorities  along  the  lines  of 
the  roads  concerned. 

(2)  The  regulations,  and  restrictions  governing  railroad 
transportation  during  yellow  fever  epidemics  shouldbe  of  such 
a  character  as  to  afford  all  reasonable  guaran  tees  of  protection 
to  the  communities  in  danger  of  invasion  by  the  disease ,  but 
should  not  be  more  onerous  than  the  circumstances  warrant , 
and  should  be  framed  with  due  consideration  of  the  extent  and 
character  of  the  danger  in  each  particular  case ,  and  as  affected 
by  latitude  and  seasons  of  the  year ,  and  other  qualifying  con¬ 
ditions. 

(3)  At  all  seasons  of  the  year ,  and  under  all  circumstances , 
the  simple  passage  of  railroad  trains  should  be  allowed ,  with¬ 
out  obstruction ,  even  when  carrying  sick  refugees  from  in¬ 
fected  places  to  healthy  localities  willing  to  receive  them. 

Sec.  2,  A  well  digested  quarantine  formula,  making  and 
promulgating  the  necessary  rules  and  regulations  for  enforc¬ 
ing  the  same ,  should  be  prepared ,  ready  to  be  put  in  force 
when  necessary  to  do  so,  at  all  points  tvhere  it  is  necessary  to 
put  quarantine  in  force.  These  rules  should  be  published  for 
general  information ,  to  enable  all  persons  to  comply  with  the 
same,  and  displayed  by  placard  in  every  depot. 

Upon  motion,  Section  (2)  was  adopted  as  the  sense  of  the 
Conference. 

Sec.  3.  At  quarantine  stations  accommodations  should 
be  provided  for  caring  for  such  persons,  if  any,  as  may  be 
detained  or  are  not  permitted  to  pass  through  such  stations , 
while  in  transit,  until  they  can  be  disposed  of. 

Upon  motion,  Section  (3)  was  adopted  as  the  sense  of  the 
Conference. 


r 


21 

Sec.  4.  Only  competent  physicians,  who  have  had  experi¬ 
ence  with  contagious  and  infectious  diseases ,  should  he  made 
inspectors  at  quarantine  stations ,  whose  duty  it  shall  he  to 
inspect  and  examine  the  condition  of  passengers,  baggage  and 
express  matter.  All  inspectors  should  have  the  power  to  ad¬ 
minister  oaths,  and  to  remove  from  the  trains,  and  detain  at 
quarantine  stations  such  passengers,  baggage  or  express  mat¬ 
ter,  &c.,  as  may  he  found  necesssary  to  prevent  the  introduc¬ 
tion  or  spread  of  infectious  or  contagious  diseases  of  any 
hind. 

Upon  motion,  Section  (4)  was  adopted  as  the  sense  of  the 
Conference. 

Sec.  5.  This  committee  recommend* that  section  5  be  not 
adopted. 

Upon  motion,  Section  (5)  above  of  committee  report  was  re¬ 
jected,  and 'the  Conference  adopted  Section  (5)  of  Mr.  Clark’s 
paper,  as  follows  : 

5.  State  hoards  of  health  should  he  the  powers  authorized  to 
put  quarantine  inforee.  They  should  determine  when,  where 
and  for  what  length  of  time  quarantines  should  he  maintained ; 
provide  the  means  necessary  for  enforcing  the  same,  and  pro 
mulgate  rules  and  regulations  for  conducting  quarantines. 

Presidents  and  secretaries  of  state  hoards  should  he  required 
to  visit  and  inspect  all  quarantine  stations,  as  often  as  practi¬ 
cable,  during  the  existence  of  such  quarantines , ;  and  to  mate 
public,  over  their  signatures  and  official  posit  ions,  the  general 
condition  of  the  public  health  at  the  points  where  quarantines 
are  established,  and  the  localities  affected  by  such  quarantines. 
Local  health  officers,  municipal  or  county  authorities,  may  es¬ 
tablish  quarantine  regulations,  conferring  with  the  state  hoard, 
if  deemed  necessary,  for  co-operation.  The  regulations  for 
governing  local  quarantines  should  not  he  in  conflict  with  the 
rides  and  regulations  adopted  by  the  state  hoards  of  health  for 
enforcing  quarantine  regulations. 


22 


Sec.  6.  The  refuge  stations  as  at  present  operated  on  the 
sea-coast  of  the  United  States  are ,  in  the  opinion  of  this  body , 
of  infinite  service ,  and  we  would  recommend  their  continuance 
in  a  full  equipment  for  all  requirements . 

A  substitute  was  offered  by  Mr.  Foreman  of  Louisiana  in 
lieu  of  Section  (6) ;  which,  on  motion,  was  tabled.  For  subst¬ 
itute,  see  Appendix  Y. 

Upon  the  resolution  of  Mr.  Foreman,  Dr.  Austin  of  Louisi¬ 
ana,  upon  personal  privilege  being  granted  by  the  Conference, 
spoke  as  follows  :  See  Appendix  YI. 

Substitute  offered  by  Dr.  Thompson  of  Kentucky,  in  lieu  of 
Section  (6). 

Resolved ,  That  it  is  the  sense  of  this  Conference  that  it  is  the  duty  of 
the  Government  of  the  United  States  to  take  charge  of  the  entire  mari¬ 
time  quarantine  service  of  this  country,  and  to  devise  and  execute  such 
a  system  as  will  protect  the  country  against  the  introduction  of  conta¬ 
gious  and  infectious  diseases. 

On  motion,  substitute  was  tabled. 

Upon  motion,  Section  (6)  of  committee  report,  as  above,  was 
adopted  as  the  sense  of  the  Conference. 


Sec.  7.  When  any  suspicious  case  occurs,  the  nature  of  which  has 
not  or  can  not  be  determined  at  its  then  present  stage,  or  doubts  arise 
as  to  the  nature  of  the  case,  wise  precaution  demands  that  such  case  be 
immediately  isolated  from  contact  with  all  other  persons  until  medical 
science  has  diagnosticated  the  case,  and  is  able  to  determine  the  nature 
of  it,  beyond  doubt.  When  conclusions  are  reached  they  should  be 
made  public.* 


Substitute  for  Section  (S)  of  Mr.  Clark’s  paper : 

Experience  has  proven  that  by  proper  precautions,  closed  cars  bear¬ 
ing  passengers  or  freight  maybe  run  through  infected  localities  without 
danger  of  infection. 


By  motion  of  Dr.  Cochran,  Section  (8)  of  report  was  laid  on 
the  table,  its  purpose  having  been  accomplished  by  another  res¬ 
olution. 


Sec.  9.  In  the  depopulation  of  infected  houses,  districts  or  cities, 
inhabitants  should  be  removed  into  camps  of  probation,  or  into  vacant 
houses  in  the  adjacent  country.  After  twelve  days  detention,  if  they 


*  It  is  not  stated  what  was  done  with  Sec.  7. 


23 


- 


remain  well,  and  under  proper  regulations,  such  as  disinfection  of  bag¬ 
gage,  etc.,  they  may  be  discharged  from  surveillance. 

Section  (9)  was,  upon  motion,  tabled — its  purpose  having 
already  been  passed  upon  and  decided. 

Sec.  10.  j Rail  Road  agents  on  roads  under  quarantine 
surveillance  at  way  stations  should  he  required  to  refuse  to 
sell  tickets  to  any  persons  who  can  not  show  that  they  have 
not  in  twelve  days  been  exposed  to  any  source  of  infection , 
and  conductors  should  he  required  by  law  to  refuse  to  trans¬ 
port  passengers  from  way  stations  ivho  are  not  supplied  with 
tickets. 

Upon  motion,  Section  (10)  of  committee  report  was  adopted. 

Sec.  11.  Health  certificates  should  he  required  from  all 
persons  whenever  yellow  fever  prevails  in  this  country.  They 
should  he  issued  only  by  the  health  ofiicial  in  charge  of  the 
place ,  under  official  seal ,  or,  in  the  absence  of  such  seal ,  under 
the  seal  of  the  municipal  or  county  court  where  the  certificate 
originates.  In  each  certificate  the  person  to  whom  it  is  issued 
should  he  so  described  as  to  admit  of  his  identification ,  and 
should  state  the  facts  oj  the  case  fully  and  circumstantially. 
And  to  such  certificates  full  credence  should  he  given  by  all 
health  authorities.  We  must  have  honesty  and  mutual  con¬ 
fidence  amongst  those  charged  with  the  protection  of  the  pub¬ 
lic  health. 

A  uniform  system  of  certificates  should  he  adopted  by 
hoards  of  health.  We  %vould  recommend  the  following  form  : 


Name . 

Residence.  .  _ 
How  long  in 
Destination . 


,  ( Office  of  the  Board  of  Health.) 
. . {Date.) 


Health  Certificate. 


Have  you  or  your  baggage  been  exposed  to  yellow  fever  in¬ 
fection  within  the  past  thirty  days  t . 

I  solemnly  swear  that  the  answer  to  the  above  question  is 
true ,  so  help  me  God. 


Signed ,  . . 

{Name  of  Applicant.) 

Signed , . {Official. 


Upon  motion,  Section  (11)  above  was  adopted  by  the  Con¬ 
ference. 

Committee  recommend  Section  (9)  of  Mr.  Clark’s  paper, 
with  the  following  amendment,  viz : 

In  the  first  line  add  the  words,  “or  municipalities,”  after  the 
word  “  legislatures.” 

The  recommendation  was  adopted  by  the  Conference. 

Upon  examination  of  Dr.  Wilkinson’s  paper,  this  committee 
offer  the  following  resolution  : 

Resolved,  That  this  Conference  indorse  the  Holt  quaran¬ 
tine  and  disinfection  system ,  as  at  present  operated  at  New 
Orleans ,  La.,  as  the  best  one  known  for  the  prevention  of  the 

introduction  of  yellow  fever  into  the  ports  of  the  United 

* 

States ,  and  recommend  its  uniform  adoption. 

The  above  resolution  was  unanimously  adopted  by  the  Con¬ 
ference. 

Upon  motion,  the  report  of  the  committee,  as  a  whole,  and 
as  amended,  was  accepted. 

Upon  motion  of  Dr.  Wood  (N.  C.),  a  joint  committee  from 
the  two  committees,  to  edit  the  two  reports  and  put  them  in 
harmonious  shape,  was  appointed  as  follows,  viz : 

Dr.  Thomas  F.  Wood . North  Carolina, 

Dr.  Eugene  Foster . Georgia, 

Dr.  J.  D.  Plunkett . Tennessee, 


25 


Dr.  W.  F.  Hyer . Mississippi, 

Dr.  T.  Grange  Simmons..  .South  Carolina. 

Upon  motion,  Conference  adjourned. 


AFTERNOON  SESSION — SECOND  DAY. 

Called  to  order  by  President  Wilkinson  at  3.30  p.  m.  Con¬ 
ference  resumed  discussion  of  topics  presented  by  Committee 
on  Business. 

.  Topic  4.  Is  it  practicable  to  cause  depopulation  of  large 
cities? 

Tabled,  having  already  been  acted  upon. 

« 

Topic  5.  Are  probation  camps  desirable?  By  whom  should 
they  be  managed  and  supported  ?  What  period  of  time  should 
elapse  from  the  time  of  arrival  at  the  camp  until  the  granting 
of  free  pratique  ? 

Tabled,  having  already  been  acted  upon. 

Topic  6.  On  the  occurrence  of  a  case  of  yellow  fever,  what 
immediate  measures  of  isolation  are  desirable  ? 

.  Upon  motion  of  Dr.  Cochran,  the  following  resolutions  were 
adopted  as  the  answer  to  Topic  6  : 

Resolved ,  1st ,  When  one  case  or  a  few  cases  of  yellow  fever 
occur  in  any  community ,  it  does  not  follow  of  necessity  that 
the  disease  must  spread  and  become  epidemic.  On  the  con¬ 
trary ,  the  experience  of  many  countries  through  long  periods 
of  time  shows  conclusively  that  in  the  majority  of  such  in¬ 
stances,  and  without  the  observance  of  any  special  means  of 
prophylaxis,  the  disease  fails  to  spread. 

2 d,  When  one  case  or  a  few  cases  of  yellow  fever  occur  in 
any  community,  in  the  light  of  our  present  knowledge  of  the 


/ 


26 


habits  and  modes  of  propagation  of  the  disease ,  it  is  generally 
possible ,  ft?/  the  employment  of  the  proper  prophylactic  meas¬ 
ures,  to  prevent  the  development  of  an  epidemic. 

3d,  The  golden  rule  for  the  prevention  of  yellow  fever  is 
non- inter  course — isolation — the  beeping  of  the  well  away 
from  the  side,  away  from  infected  things,  and  very  especially 
away  from  infected  localities. 

4 th,  In  the  enforcement  of  this  golden  rule  of  non-inter¬ 
course  two  problems  present  themselves  jor  solution,  (a)  To 
beep  the  people  generally  from  coming  into  the  infected  houses 
and  the  infected  localities ;  and  (b)  to  beep  doctors  and  nurses 
and  other  attendants ,  and  the  ivell  members  of  sicb  families, 
from  visiting  and  mingling  ivith  people  outside  of  the  infected 
houses  and  localities.  The  solution  of  the  first  of  these  prob¬ 
lems  is  comparatively  easy ,  The  solution  of  the  second  is 
sufficiently  difficult.  But  it  is  possible  to  solve  them  both. 

5tli,  In  the  densely  settled  sections  of  cities  guards  maybe 
useful  for  the  enforcement  of  non-intercourse.  They  are 
much  less  needed  in  sparsely  settled'  towns.  In  villages  and 
country  neighborhoods ,  as  a  rule,  they  are  not  needed  at  all. 
In  all  cases  every  intelligent  family  should  be  able  to  tale  care 
of  itself — should  be  able  to  beep  all  of  its  members  away  from 
infected  houses  and  localities,  and  to  guard  its  oivn  premises 
from  invasion  by  dangerous  persons  and  things. 

6th,  Non-intercourse  may  be  practiced  in  the  very  centre  of 
an  infected  district  with  considerable  probability  of  escaping 
the  fever.  Cloistered  convents  and  prisons  in  infected  cities, 
with  yellatv  fever  raging  all  around  them,  usually  escape 
invasion ;  and  there  are  numerous  instances  on  record  in 
which  private  families  in  the  midst  of  epidemics  have  passed 
the  ordeal  safely  by  the  vigorous  enforcement  of  non-inter¬ 
course. 


Topic  7.  What  means  of  disinfection  should  be  adopted 
for  chambers  and  dwellings  where  cases  of  yellow  fever  have 
occurred  ? 


27 


Dr.  Cochran  moved  the  following  resolutions  in  answer  to 

Topic  7: 


1.  Disinfection  in  yellow  fever  is  based  very  largely  on  theoretical 
grounds.  Nevertheless  we  believe  that  it  may  be  made  a  valuable 
agent  in  checking  the  spread  of  the  disease.  In  the  beginning  of  an 
outbreak  all  the  resources  of  disinfection  should  be  exhausted,  and  these 
efforts  should  be  continued  until  the  epidemic  is  fully  established.  Af¬ 
ter  the  epidemic  has  subsided,  disinfection  is  of  very  questionable  value. 

2.  The  disinfecting  agents  most  to  be  trusted  are  heat,  especially 
moist  heat ;  cold,  both  artificial  and  natural,  and  especially  cold  weather 
and  frost ;  and  certain  chemicals,  especially  the  bichloride  of  mercury 
and  the  fumes  of  burning  sulphur.  To  these  must  be  added  ventila¬ 
tion. 

3.  The  disinfection  of  beds,  bedding,  clothing,  and  articles  of  simi¬ 
lar  character,  is  comparatively  easy.  The  disinfection  of  single  rooms, 
and  perhaps  also  of  single  houses,  is  more  difficult  but  not  entirely  im¬ 
practicable.  The  disinfection  of  yards  must  be  regarded  as  very  diffi¬ 
cult,  but  in  the  beginning  of  an  outbreak  it  should  be  attempted.  The 
disinfection  of  a  whole  city,  or  even  of  a  large  section  of  a  city,  seems 
not  to  be  practicable. 


on  Id 


Dr.  Simons  said  the  adoption  of  the  resolutions  w 
commit  this  Conference  to  a  very  bad  thing. 

He  thought  that  sanitarians  had  differed  widely  on  the  sub¬ 
ject  of  disinfection,  and  moved  to  strike  out  the  last  sentence 
of  the  first  resolution. 


no 


(ion  H  ri  I  n  rv  Ido  cnonot  fr\ 

w  o  a  *.  jk  Uiu  ^  4i  io  o  fw»  tv 


the  Conference,  Dr.  Simons  said  the  Conference  ought  to 
allay  public  feeling,  and  ought  to  feel  the  commercial  pulse. 
He  moved  to  strike  out  the  last  section  of  the  second  resolu¬ 
tion. 

Dr.  Daniel  seconded  the  motion  in  a  short  speech.  He  said 
that  disinfection  did  a  great  deal  towards  controlling  the  moral 


demoralization  of  the  people. 

Dr.  Sternberg  said  that  yellow  fever  was  brought  to  America 
from  Havana  or  other  places.  The  disease  was  a  something  to 
be  destroyed,  and  he  thought  the  effort  to  destroy  it  ought  at 
least  to  be  made.  Everything  indicated  that  the  yellow  fever 
germ  was  not  very  hardy  and  could  easily  be  killed.  He 
thought  it  a  little  less  than  criminal  for  health  boards  to  leave 
anything  in  the  way  of  disinfection  at  the  beginning  or  during 
any  part  of  the  epidemic.  (Applause.) 


28 


Mr.  Moyle  related  his  experience  at  Gainesville,  Fla.,  during 
the  epidemic  of  last  summer. 

Dr.  Plunkett  moved  to  strike  out  the  first  and  last  resolu¬ 
tions. 

Dr.  Bailey  thought  the  profession  differed  very  materially 
on  the  question  of  disinfection. 

Dr.  Vaughan  said  that  disinfection  was,  in  some  diseases,  es¬ 
pecially  in  scarlet  fever  and  diphtheria,  a  sure  means  of  pre¬ 
venting  the  spread  of  infection  or  contagion,  and  was  even 
better  than  quarantine.  It  was  going  to  be  one  of  the  greatest 
methods  of  limiting  diseases  in  future. 

Dr.  Cochran  said  that  disinfection  was  a  question  of  great 
importance.  He  agreed  with  Drs.  Sternberg  and  Vaughan. 
He  was  not  opposed  to  disinfection,  but  the  anfount  of  good  it 
had  accomplished  in  epidemics  of  yellow  fever  was  very  ques¬ 
tionable.  He  said  the  only  place  thoroughly  disinfected  in 
his  knowledge  was  Plant  City  last  summer,  but  even  there  it 
failed.  After  refugees  were  allowed  to  return  the  disease 
broke  out  again  in  a  few  days.  Whenever  infection  appeared 
he  was  heartily  in  favor  of  going  for  it  and  using  every  means 
in  the  world  to  stamp  it  out.  He  thought  post  epidemic  dis¬ 
infection  unnecessary,  and  moved  to  refer  the  whole  subject 
matter  to  a  committee  to  be  appointed  by  the  chair.  Lost. 

The  following  resolutions  introduced  by  Dr.  T.  Grange 
Simons,  of  South  Carolina,  and  Dr.  Thos.  F.  Wood,  of  North 
Carolina,  was  adopted  as  the  sense  of  the  Conference  in  an¬ 
swer  to  Topic  7. 

Resolved,  That  this  Conference  recommend  that  all  approved 
methods  of  disinfection  by  means  of  personal  and  municipal 
cleanliness,  by  ventilation,  fumigation,  chemical  affusion,  destruc¬ 
tion  by  fire  of  all  infected  or  suspected  things  used  during  an 
epidemic  of  yelloiv  fever  and  until  the  danger  of  its  spread  shall 
have  passed ,  and  that  all  fomites  should  be  disinfected  after  the 
recovery  of  the  sick. 

We  recommend  as  a  basis  of  disinfection  the  processes  as  set 
forth  by  the  Committee  on  Disinfectants,  of  the  American  Public 
Health  Association. 


f 


29 


Major  Hadden,  of  Memphis,  offered  the  following  : 

Resolved,  That  Decatur,  Alabama,  be  thoroughly  disinfected  at  once, 
and  that  the  proper  authorities  are  requested  to  do  so  immediately. 

Dr.  Cochran  said  there  was  no  use  in  adopting  the  resolution 
for  he  would  assure  the  Conference  that  no  such  thing  would 
be  done. 

Mr.  Austin,  of  Hew  Decatur,  said  he,  in  the  name  of  the 
women  and  children  and  united  people  of  Decatur  had  urged 
on  the  government,  state  and  national,  to  burn  the  bedding  and 
other  things  now  lying  in  a  hundred  houses  in  the  town 
where  fever  had  raged. 

He  read  a  letter  from  Gov.  Seay  recommending  that  the 
United  States  government  send  an  inspector  there  to  see  what 
ought  to  be  done.  He  also  gave  a  history  of  the  Decatur 
boom.  He  said  that  the  city  of  Decatur  had  appealed  in  the 
name  of  all  that  was  dear  to  them,  but  not  one  had  ever 
reached  the  heart  of  the  state  health  officer.  He  said  that  he 
could  make  a  statement  to  the  floor  that  would  melt  a  heart  of 
stone. 

Dr.  Cochran  said  all  the  eloquence  of  the  gentlemen  was 
based  upon  the  assumption  that  the  poison  of  yellow  fever  was 
still  lurking  in  the  yards  and  houses,  and  amongst  the  bedding 
and  clothing  of  the  people  in  Decatur.  But  if  the  assumption 
was  wrong  the  eloquence  and  pathos  would  be  eloquence  and 
pathos  still,  but  they  ought  not  to  have  any  effect  in  controlling 
the  suffrages  of  this  Conference.  All  the  facts  went  to  show 
that  there  was  not  the  shadow  of  proof — not  a  particle  of  evi¬ 
dence  that  the  infection  still  existed  in  Decatur.  If  it  did 
exist  why  didn’t  those  people  who  went  back  after  the  epi¬ 
demic  ended  have  the  fever?  Was  there  a  single  person  on 
this  floor  who  believed  that  yellow  fever  infection  remained  in 
Decatur?  The  state  of  Alabama  had  the  money  to  do  the 
work  asked  for,  and  hevhad  control  of  it,  but  he  would  cut  off 
bis  right  hand  before  he  would  do  this  work.  The  doing  of  it 
would  only  result  in  adding  another  horror  to  yellow  fever, 
and  it  had  enough  already.  If  the  Conference  granted  the  ap¬ 
peal  of  Mr.  Austin  it  would  controvert  the  whole  yellow 


30 


fever  history  of  the  world.  He  hoped  the  Conference  would 
not  be  unduly  moved  by  such  appeals. 

Mr.  Yoyle  offered  the  following : 

Resolved,  That  the  city  of  Decatur  can  furnish  a  valuable  example  of 
the  efficacy  or  otherwise  of  disinfection  by  omitting  any  further  action 
in  that  direction,  and  that  they  can  perform  a  patriotic  act  of  humanity 
by  such  action. 

Dr.  Hyer,  of  Mississippi,  thought  the  prayer  of  Decatur 
ought  to  be  answered. 

Dr.  Bizzell  was  opposed  to  the  adoption  of  a  resolution  im¬ 
peaching  the  character  of  a  health  officer  who  had  commanded 
the  admiration  of  everybody.  (Applause.) 

Dr.  Baird  thought  it  would  be  discourteous  to  the  state  to 
censure  her  governor  or  state  health  officer. 

Dr.  Weatherly  said  that  frost  was  the  best  disinfectant 
known. 

Dr.  Thornton  said  he  was  not  going  to  take  any  part  in  the 
local  fight  about  the  city  of  Decatur,  but  he  wanted  to  say  a 
few  words.  He  said  that  no  man  had  ever  stated  or  proved 
that  yellow  fever  was  imported  to  Memphis  in  1879.  It  was 
his  opinion  that  it  had  been  nursed  in  bedding,  mattresses,  etc., 
which  were  left  over  from  the  epidemic  of  1878.  He  thought 
Decatur  ought  to  be  thoroughly  disinfected. 

Dr.  Bailey  thought  it  would  not  be  courteous  to  their  host 
the  state  of  Alabama,  and  moved  to  table  the  resolutions  and 
amendments.  Adopted. 

Topic  8.  What  system  of  disinfection  should  be  adopted 
for  personal  baggage  of  persons  fleeing  from  an  infected 
place  ? 

Dr.  Hamilton  said  that  when  the  question  of  the  escape  of 
people  from  infected  Florida  came  up  last  summer  there  was 
no  time  to  prepare  elaborate  machinery  for  the  disinfection  of 
baggage.  He  detailed  how  baggage,  etc.,  was  disin  fected  in  a  box 
car  at  every  crossing  during  the  beginning  of  the  Jacksonville 
epidemic,  and  later  how  a  warehouse  was  constructed.  He 
thought  the  government  ought  to  construct  cars  with  steel 


/ 


31 


chambers,  with  super-heated  steam,  so  as  to  move  from  place  to 
place  as  the  exigencies  of  the  case  demanded.  Such  plans  had 
already  been  filed  at  government  headquarters,  and  he  hoped 
to  have  the  cars  ready  in  case  they  should  be  needed. 

Upon  motion  of  Dr.  Wilkinson,  it  was 

Resolved ,  That  it  is  the  sense  of  this  Conference ,  that  the 
best  form  of  disinfectant  for  personal  baggage  is  moist  heat. 

Moved,  that  the  hearing  of  the  papers  by  Drs.  Sternberg, 
Vaughn,  Burgess,  and  VanBibber,  be  the  next  order  of  busi¬ 
ness  for  the  Conference.  Adjourned. 


NIGHT  SESSION— SECOND  DAY. 

Called  to  order  by  President  Wilkinson  at  8  p.  m. 

The  following  resolution,  introduced  by  Col.  J.  C.  Clark,  of 
Alabama,  was  adopted  : 

Whereas,  This  Quarantine  Conference  has  adopted'  the  report 
of  the  Committee  on  Inland  Quarantine  ;  therefore ,  be  it 

Resolved ,  That  a  committee  of  one  from  each  state  repre¬ 
sented  in  this  Conference  be  appointed  to  prepare  rules  and 
regulations  for  governing  quarantines ,  when  it  becomes  neces¬ 
sary  to  put  the  same  in  force.  And  that  such  rules  be  published 
when  prepared  for  the  information  of  the  public ,  and  cdl  per¬ 
sons  to  be  affected  thereby.  And  that  state  boards  of  health  and 
health  officers  of  states  be  requested  to  furnish  such  rules  to  the 
proper  officers  of  municipal  and  county  authorities  for  their  in¬ 
formation, , 

Dr.  Geo.  M.  Sternberg,  U.  S.  A.,  read  his  paper  on  “Hunt¬ 
ing  Yellow  Fever  Germs”  with  magic  lantern  illustrations. 
For  paper  see  Appendix  VII. 

By  motion  a  vote  of  thanks  of  the  states  assembled  was  ten¬ 
dered  Dr.  Sternberg  for  the  very  entertaining  address  and  ex¬ 
hibit  with  which  he  had  favored  the  Conference. 

Dr.  Victor  C.  Vaughan,  who  had  been  announced  to  read  a 


paper,  stated  that  owing  to  the  lateness  of  the  hour  he  would 
address  the  Conference  briefly  upon  the  subjects  covered  by 
his  paper  in  lieu  of  reading  the  paper.  Whereupon  he  ad¬ 
dressed  the  Conference. 

By  motion  a  vote  of  thanks  of  the  Conference  in  the  name 
of  the  states  assembled  was  tendered  to  Dr.  Yaughan  for  his 
very  interesting  address. 

By  motion  Drs.  Sternberg  and  Yaughn  were  requested  to 
furnish  copies  of  their  respective  papers  for  publication  with 
the  Proceedings  of  the  Conference.  For  Dr.  Yaughan’s 
paper,  see  Appendix  YIII. 

Adjourned. 


MOBNING  SESSION— THIKD  DAY. 


Called  to  order  by  President  Wilkinson  10  a.  m.  The 
Chair  announced  the  committee  proposed  by  Mr.  Clark’s  reso¬ 
lution  of  the  Wednesday  evening  session  as  follows  : 

Committee  on  Promulgation  of  Buies  for  Quarantine  Manage¬ 
ment — 


J.  C.  Clark . 

J.  B.  Baird . 

J.  Y.  Porter . 

B.  S.  Starkweather 

Wm.  Bailey . 

H.  B.  Horlbeck. . . 

J.  E.  Black . 

B.  Butherford .... 

B.  F.  Gray . 

O.  B.  Early . 

C.  M.  Smith . 


. Alabama. 

. Georgia. 

. Florida. 

. . Illinois. 

. Kentucky. 

.South  Carolina. 

. Tennessee. 

. Texas. 

North  Carolina. 
....  Mississippi. 
. Louisiana. 


Dr.  Daniel  M.  Burgess,  sanitary  inspector  M.  H.  S.  at 
Havana,  read  the  following  paper  on  “The  Sanitary  Inspection 
Service  at  Havana,  Island  of  Cuba.”  For  paper,  see  Ap¬ 
pendix  IX. 

Dr.  Palmer,  of  Florida,  desired  that  the  paper  be  discussed 
by  the  Conference.  He  had  heard  the  threat  often  that  the 


33 


state  of  Florida  would  be  cut  off  unless  all  intercourse  between 
that  state  and  Cuba  was  prohibited. 

Dr.  Daniel,  of  Florida,  made  a  statement  as  to  the  danger  of 
Florida,  and  asked  Dr.  Burgess  several  questions  regarding  the 
inspection  at  Havana. 

►  Dr.  Wilkinson  took  the  floor  and  stated  his  experience  as  to 

the  reliability  of  health  certificates  issued  by  United  States 
consuls,  and  cited  instances  where  the  same  consul  had  issued 
*  two  certificates  entirely  different  in  nature,  both  issued  the 
same  day.  Dr.  Wilkinson  then  gave  an  outline  of  the  methods 
of  the  Tampa  quarantine  in  connection  with  the  Plant  steam¬ 
ship  line,  giving  the  requirements  made  of  a  passenger  before 
he  is  allowed  to  land.  He  thought  that  it  was  useless  to  in¬ 
dulge  in  crimination  or  recrimination  regarding  the  origin  of 
yellow  fever  in  Jacksonville;  rather  let  Tampa  quarantine  be 
considered,  and  let  it  be  shown  whether  or  not  it  would  be 
possible  to  introduce  fever  into  Tampa  by  the  Plant  line  of 
steamers  in  spite  of  the  Tampa  quarantine  ? 

Dr.  Wall  had  given  the  subject  of  the  Tampa  quarantine 
much  study,  and  he  was  satisfied  that  it  is  not  shown  that  a 
single  case  of  fever  was  ever  brought  into  Florida  by  the 
steamers  of  this  line.  Ho  quarantine  is  perfect,  but  the  Tampa 
quarantine  was  as  good  as  any  in  existence. 

Mr.  Ingraham,  representing  the  Plant  line,  made  a  state¬ 
ment  to  the  Conference  of  the  methods  in  use  on  the  steamers 
on  that  line  to  prevent  the  possibility  of  bringing  the  germs  of 
yellow  fever  to  this  country.  He  detailed  the  construction  of 
the  vessels  used  and  the  measures  of  fumigation  to  which  all 
baggage  is  subjected.  He  stated  that  the  company  had 
more  than  one  thousand  claims  for  damage  done  to  fine  cloth¬ 
ing  by  the  fumigation.  He  concluded  by  assuring  the  Con¬ 
ference  that  the  Plant  system  did  not  desire  to  endanger  the 
health  of  the  entire  country,  and  if  it  was  so  regarded  the  com¬ 
pany  would  discontinue  its  steamers. 

Dr.  T.  Grange  Simons,  of  South  Carolina,  thought  that  dis¬ 
infection  was  in  a  state  of  experiment,  and  at  this  time  the 

3 


34 


only  point  at  which  this  system  is  in  any  way  perfect  is  at  New 
Orleans.  He  did  not  think  there  was  any  assurance  that  the 
Plant  system  of  fumigation  was  at  all  times  enforced. 

Dr.  Cochran  thought  that  the  Plant  system  had  done  more 
than  any  line  of  vessels  coming  to  this  country.  He  was  of  the 
opinion  that  rather  than  increase  the  restrictions  of  the  com¬ 
pany  they  should  be  relaxed  ;  that  it  is  doing  much  more  than  is 
done  on  any  line  of  vessels  going  to  New  Orleans.  If  anything 
is  done  to  further  protect  this  country,  it  should  be  at  the 
port,  and  he  suggested  that  a  fumigation  or  disinfectant  station 
be  established  at  Tampa.  He  thought  that  a  legitimate  route 
or  line  of  travel  between  Cuba  and  the  United  States  would 
tend  to  decrease  the  probability  of  introduction  of  disease  into 
this  country. 

Dr.  Porter  followed,  giving  a  detailed  history  of  the  appear¬ 
ance  of  yellow  fever  into  Ivey  West  in  1887,  and  the  manner 
of  its  introduction.  He  reverted  to  the  Plant  steamers,  and 
gave  it  as  his  opinion  that  those  vessels  were  so  constructed  as 
to  render  them  very  easily  cleaned.  Something  had  been  said 
about  Dr.  Nelson’s  “blue  suit”  which  he  wore  from  Havana  to 
Tampa  without  disinfection.  Dr.  Porter  said  the  suit  which  he 
was  wearing  had  been  many  times  in  contact  with  yellow  fever 
patients.  It  had  never  been  fumigated,  but  still  it  had  been 
aired,  and  there  was  absolutely  no  danger  in  it  now,  and  no 
more  was  there  in  Dr.  Nelson’s  blue  suit. 

Dr.  Hamilton  followed,  giving  an  outline  of  the  working  of 
the  consular  weekly  report  system,  with  a  few  items  of  the 
cost  of  obtaining  information  by  cable  and  the  extreme  diffi¬ 
culty  of  consuls  to  obtain  correct  information.  He  stated  that 
the  Spanish  government  at  first  objected  to  placing  Dr.  Bur¬ 
gess  as  a  yellow  fever  inspector  at  Havana,  and  that  he  wTas 
only  allowed  to  remain  at  the  earnest  solicitation  of  the  secre¬ 
tary  of  state.  He  spoke  of  the  need  of  physicians  being  at¬ 
tached  to  the  consulates  in  countries  in  which  epidemic  diseases 
are  endemic,  and  he  hoped  the  Conference  would  adopt  a  reso¬ 
lution  calling  on  congress  to  take  this  action.  He  favored  the 
appointment  of  inspectors  at  every  port  of  entry  in  the  coun- 


35 


try,  and  vthe  increase  of  inspectors,  but  he  did  not  think  it 
would  be  necessary  to  establish  more  quarantine  stations.  He 
would  recommend  under  the  new  quarantine  law,  that  when  a 
vessel  reached  any  port  in  this  country  in  a  filthy  condition,  it 
would  be  subjected  to  ordinary  fumigation,  and  in  the  event  of 
*  the  second  arrival  of  the  same  ship  within  a  year,  in  a 
filthy  condition,  it  would  be  subjected  to  an  extraordinary 
fumigation.  The  cost  of  these  fumigations  would  cause  the 
-  vessel  owners  to  be  more  careful  as  to  the  cleanliness  of  their 
vessels.  He  had  visited  the  vessels  which  brought  yellow  fever 
to  Pensacola  the  last  time  that  disease  was  brought  there,  and 
he  had  found  it  the  filthiest  ship  he  had  ever  seen.  Hr.  Hamil¬ 
ton  then  gave  an  outline  of  the  proposed  quarantine  stations  at 
Dry  Tortugas  and  the  Pacific  coast. 

Dr.  Wilkinson  introduced  the  following  resolution,  which 
was  unanimously  adopted  as  the  sense  of  the  Conference.  The 
resolution  read  as  follow  : 

Be  it  Resolved ,  That  the  secretary  of  the  Treasury  of  the 
United  States  is  hereby  requested  to  increase  the  revenue  'patrol 
service  on  the  coast  of  Florida  to  such  extent  as  may  he  neces¬ 
sary  to  prevent  smuggling. 

The  following  resolutions,  introduced  by  Drs.  Wood  and 
Foster,  were  adopted  : 

BY  DR.  WOOD  OF  NORTH  CAROLINA. 

Whereas,  It  appears  by  the  report  which  Dr.  Burgess  has 
made  to  this  conference ,  that  sanitary  inspection  of  vessels  ivhere 
yellow  fever  is  endemic  is  of  vital  importance ,  therefore  he  it 

Resolved ,  That  this  conference  approves  the  plan  of  having 
medical  inspectors  attached  to  those  considates  where  yellow  fever 
and  cholera  are  endemic ,  icith  a  vieio  of  securing  for  our  protec¬ 
tion  definite  information  as  to  the  exact  sanitary  condition ,  and 
the  presence  or  absence  of  contagious  diseases  in  such  consular 
district.  And  that  congress  be  urged  to  make  the  necessary  ap¬ 
propriations  to  carry  the  plan  into  effect. 


36 


BY  DR  FOSTER  OF  GEORGIA. 

Be  it  Resolved ,  That  the  U.  S.  government  is  hereby  re¬ 
quested ,  if  compatible  ivith  international  and  constitutional  law , 
to  enter  into  negotiations  with  Spain  ivith  a  view  of  investing 
the  U.  S.  sanitary  inspectors  at  Spanish  ports  ivith  such  legal 
jurisdiction  as  may  be  necessary  for  the  enforcement  of  such 
rules  and  requirements  as  are  provided. 

Dr.  Plunkett  offered  a  resolution  that  the  thanks  of  the 
conference  are  tendered  to  Dr.  Burgess  for  his  able  paper, 
and  that  he  be  requested  to  furnish  a  copy  for  publication. 

The  motion  was  unanimously  adopted. 

Dr.  W.  C.  VanBibber  read  the  following  paper  on  the 
“Quarantine  of  the  Future.”  For  paper  see  Appendix  X. 

On  motion,  thanks  were  tendered  Dr.  Yan  Bibber  and  a 
copy  of  paper  requested  for  publication  with  the  proceed¬ 
ings  of  the  conference. 

The  following  resolution,  introduced  by  Dr.  Harrell,  was 
tabled.  For  resolution,  see  XY. 

Dr.  Gaston,  of  Atlanta,  read  the  following  paper,  entitled 
“A  Plea  for  Yellow  Fever  Inoculation  as  a  Prophylactic 
Measure.”  See  Appendix  XI. 

Dr.  Sternberg  said  that  he  had  visited  Bio  De  Janeiro 
and  made  a  thorough  investigation  of  the  practice  of  inocu¬ 
lation  followed  there  by  Dr.  Freire.  His  voluminous  report 
was  in  the  hands  of  the  president.  He  found  Dr. 
Freire’s  statistics  fallacious.  Of  those  inoculated  by  Dr. 
Freire  a  large  number  who  had  been  exposed  died  and  large 
numbers  of  others  had  the  disease.  Dr.  Sternberg  gave  an 
explanation  of  the  manner  in  which  many  of  Dr.  Freire’s  in¬ 
oculations  were  made,  and  he  had  found  no  evidence  that 
Dr.  Freire’s  method  of  inoculation  is  of  any  practical  value. 

Dr.  Wilkinson  offered  a  resolution  to  return  the  thanks  of 
the  conference  to  Dr.  Gaston  for  his  paper,  but  in  view  of 
the  fact  that  the  theory  of  inoculation  is  new,  that  the  reso¬ 
lutions  bearing  on  the  subject  be  laid  on  the  table.  Adopted. 

The  following  letter  was  then  read  by  Dr.  Stern- 


37 


berg,  and  by  motion  a  copy  was  requested  for  publica¬ 
tion  with  the  proceedings.  For  letter  see  Appendix  XII. 

Report  of  Business  Committee  taken  up  for  further  con¬ 
sideration. 

Topic  10.  When  may  refugees  safely  return  to  their 
homes  ? 

Upon  motion  of  Mr.  Hier  (Fla.)  the  following  was 
adopted  as  the  answer  to  Topic  10  : 

I.  After  the  occurrence  of  ice, 

After  the  occurrence  of  three  (3)  killing  frosts , 

After  the  occurrence  of  no  cases  of  fever  for  the  period  of  two 
(2)  weeks ,  and  after  thorough  disinfection  and  ventilation  of  all 
localities  infected ,  and  bedding  and  such  other  articles  as  are 
capable  of  conveying  germs. 

Topic  11.  Is  there  any  authority  that  yellow  fever  will 
hibernate  from  one  year  to  another  in  the  United  States? 

Dr.  T.  Grange  Simons  took  the  position  that  it  was  pos¬ 
sible  for  fever  to  remain  dormant  from  one  year  to  another, 
and  he  thought  that  several  instances  had  been  cited  to 
prove  this. 

Dr.  Early  of  Kentucky  thought  that  there  existed  in  this 
country  a  spore,  which  in  itself  was  harmless,  but  which  be¬ 
came  fructified  by  importation  and  produced  yellow  fever. 

Dr.  Wall,  of  Florida,  gave  briefly  the  history  of  the  yel¬ 
low  fever  in  Tampa  in  1887,  and  the  measures  taken  for 
protection  of  returning  refugees. 

Dr.  Hyer  thought  that  the  question  was  one  for  scientists 
and  not  for  such  a  body  as  the  conference,  and  after  citing 
instances  of  supposed  hibernation,  which  by  many  were 
doubted,  he  offered  a  motion  that  the  subject  be  indefinitely 
postponed.  Adopted. 

Dr.  Ross  offered  the  following : 

Whereas,  Of  late  years  almost,  if  not  all  the  epidemics  of  yellow  fe¬ 
ver  which  have  occurred  in  this  country,  costing  many  millions  of  dol¬ 
lars  to  the  citizens  thereof,  besides  causing  the  loss  of  many  valuable 
lives,  have  been  directly  traceable  to  infection  brought  to  its  shores 


38 


from  the  Island  of  Cuba,  and  more  especially  the  city  of  Havana; 
therefore  be  it 

Resolved,  That  it  is  the  sense  of  this  conference  that  by  proper  means 
the  disease  can  be  stamped  out  of  the  Island  of  Cuba. 

Second,  That  it  is  the  opinion  of  this  conference  that  the  government 
of  the  United  States  should  notify  the  Spanish  government  that  the 
disease  must  be  abated,  or  brought  under  control  within  a  reasonable 
period  of  time ;  that  if  after  the  lapse  of  such  time  nothing  has  been 
done  toward  the  abatement  of  this  international  nuisance,  it  is  the  opin¬ 
ion  of  this  conference  that  the  United  States  government  should  take 
control  of  the  Island  of  Cuba  and  proceed  to  destroy  the  cause  of  dis¬ 
ease  at  its  fountain  head. 

Dr.  Plunkett  offered  as  a  substitute,  that  a  committee  of 
three  be  appointed  to  report  an  expression  of  the  confer¬ 
ence  on  the  subject. 

The  chair  appointed  Drs.  Hamilton,  Ross  and  Plunkett. 

The  following  resolution,  introduced  by  Dr.  Hamilton, 
was  reported  by  the  committee  as  the  expression  of  the 
conference  : 

Resolved ,  That  this  conference  is  of  the  opinion  that  it  is  a 
duty  devolving  on  all  nations  to  take  measures  to  eradicate  any 
plague  centers  from  their  territory ,  and  that  the  existence  of  such 
plague  centers  is  a  menace  to  all  other  nations ,  and  that  our  state 
department  he  requested  to  take  measures  through  proper  diplo¬ 
matic  channels  for  the  conveyance  of  this  opinion  to  the  govern¬ 
ments  deemed  obnoxious  to  the  opinion  as  herein  expressed. 

Adopted. 

Dr.  Hamilton  offered  a  resolution  returning  thanks  of  the 
conference  to  Dr,  Jerome  Cochran,  State  Health  Officer  of 
Alabama.  Adopted. 

Dr.  Hamilton  offered  a  resolution,  returning  thanks  of  the 
conference  to  president  Wilkinson,  for  his  impartial  dis¬ 
charge  of  the  duties  of  presiding  officer.  Adopted. 

Dr.  Eoster  offered  a  resolution,  returning  thanks  to  the 
secretary  for  the  discharge  of  his  duties  and  to  the  press 
for  full  reports  of  proceedings.  Adopted. 

Conference  adjourned  sine  die. 


39 


The  report  on  Quarantine  Buies  and  Begulations  is  to 
be  prepared,  by  the  Committee  appointed  for  that  purpose, 
after  the  adjournment  of  the  Conference. 

J.  L.  LUDLOW,  C.  E., 

Acting  Secretary. 


RULES  FOR  RAILROAD  QUARANTINE. 

The  rules  of  the  government  of  railroad  quarantines,  as 
drawn  up  by  the  special  committee  appointed  for  that  pur¬ 
pose,  are  here  subjoined  : 

The  committee  was  composed  of  J.  C.  Clark,  J.  B.  Baird, 
J.  R.  Porter,  R.  S.  Starkweather,  Wm.  Bailey,  H.  B.  Holr- 
beck,  J.  E.  Black,  R.  Rutherford,  R.  F.  Gray,  O.  R.  Early, 
C.  M.  Smith. 

RULES  PREPARED  BY  THE  COMMITTEE. 

* 

1.  Quarantine  should  not  he  made  against  any  place  until 
it  is  officially  knoivn  that  yellow  fever  or  other  infectious  or  con¬ 
tagious  disease  exists  at  such  place. 

2.  Only  competent  physicians  should  he  put  in  charge  of 
quarantine  stations ;  and  only  thoroughly  qualified  persons  should 
he  employed  as  inspectors  on  railway  trains. 

3.  Quarantine  stations ,  located  on  railroads ,  should  he  es¬ 
tablished  at  convenient  points ,  on  one  or  both  sides  of  a  town  or 
station ,  as  may  he  deemed  necessary. 

f  If  an  epidemic  of  yelloio  fever  or  other  infectious  or 
contagious  disease  exist  at  a  town  or  station ,  trains  carrying 
passengers  or  freights  should  he  required  to  qictss  through  thelim - 


40 


its  of  such  towns  or  stations  at  a  speed  of  not  less  than  ten  \10 ] 
miles  per  hour ,  icithout  stopping  at  such  toivns  or  stations,  hut 
should  stop  at  the  quarantine  station. 

5.  Passengers  to  or  from  such  infected  point  should  only  he 
received,  or  delivered  at  the  quarantine  station,  under  the  super¬ 
vision  of  the  quarantine  officer  in  charge  of  the  station. 

6.  Railway  tickets  may  he  sold  to  persons  leaving  an  in¬ 
fected  place  to  any  point  willing  to  receive  them. 

7.  All  baggage  from  any  inf ected  point  should  he  properly 

8.  As  far  as  practicable,  the  same  rides  proposed  for  rail¬ 
roads  should  he  applied  to  vessels  of  every  kind,  stage  coaches, 
or  other  means  of  travel. 

9.  The  passage  of  railroad  trains  through  any  point  on  the 
line  of  road,  whether  infected  or  not,  should  not  be  prohibited 
by  any  quarantine  regulations.  The  conductors  of  passenger 
trains  should  close  the  windows  and  ventilators  and  lock  the 
doors  of  cars  passing  through  any  place  where  a  train  is  not 
permitted  to  stop. 

10.  All  f  reight  to  any  infected  place  should  be  delivered 
either  at  the  quarantine  station  or  the  nearest  railway  station 
to  such  infected  point ,  where  it  can  be  properly  cared  for. 

11.  All  mail  matter  from  any  infected  place  should  be  prop¬ 
erly  disinfected  by  the  United  States  Government.  And  mail 
matter  intended  for  inf ected  points  should  be  put  off  the  trains 
at  the  quarantine  stations.  The  United  States  Government 
should  instruct  Post-Masters  to  receive  and  deliver  mails  at 
such  quarantine  stations. 

1 <2.  Railroads  and  Express  Companies,  may  receive  for 
transportation  from  any  inf  ected  place,  during  the  time  such 
infection  exists,  any  merchandise  or  traffic  consigned  to  places 
willing  to  receive  it. 

IS.  State  authorities  should  employ  competent  persons  on 
passenger  trains,  as  inspectors  of  passengers,  baggage  and  ex¬ 
press  matter,  as  additional  precaution',  but  the  fact  of  inspect¬ 
ors  being  on  such  trains  shoidd  not  relieve  trains  carrying  pas- 


41 


sengers ,  or  express  matter  or  baggage ,  f  rom  stopping  at  quar¬ 
antine  stations  for  sack  inspection  as  the  officer  in  charge  may 
determine  to  be  necessary. 

If  It  is  recommended  that  all  quarantines,  as  far  asprac- 
*  ticable,  should  be  uniform  in  their  requirements  and  operations , 

f  which  will  greatly  contribute  to  the  prevention  of  panics,  and 

tend  to  allay  unnecessary  excitement  and  fear  on  the  part  of 
.  the  people. 

15.  The  form  of  health  certificate  adopted  by  the  quarantine 
convention ,  held  at  Montgomery  March  5,  1889,  should  be  pre¬ 
pared  for  Health  Officers  to  issue,  to  such  persons  as  may  be 
found  entitled  to  receive  the  some.  A  copy  of  this  certificate 
should  be  printed  ivith  these  rides,  and  conspicuously  posted  at 
railway  stations. 

16.  It  is  the  desire  and  intention  of  health  authorities,  as  far 
as  practicable,  to  throw  every  safe-guard  around  the  public 
health  of  all  localities.  Municipal,  county  and  state  authorities 
are  expected  to  co-operate  in  every  possible  way  with  health  of¬ 
ficers  located  in  towns ,  villages  and  cities,  and  in  charge  of  quar¬ 
antine  stations,  to  enable  them  to  prevent  the  introduction  or 
spread  of  yellow  fever  or  other  infectious  or  contagious  diseases. 


* 

INTER-STATE  NOTIFICATION  OF  INEECTIOUS  AND 

CONTAGIOUS  DISEASES. 


The  rules  in  regard  to  Inter-State  Notification,  adopted 
by  the  conference  of  State  Boards  of  Health,  which  are  refer¬ 
red  to  in  these  proceedings,  are  here  subjoined  for  conve¬ 
nience  of  reference. 

The  following  are  the  resolutions,  adopted  by  the  Inter- 


42 


national  Conference  of  Boards  of  Health,  at  Toronto,  Octo¬ 
ber  6 tli,  1886,  with  slight  verbal  modifications. 

Whereas,  It  is  necessary  for  the  protection  and  preservation  of  the 
public  health  that  prompt  information  should  be  given  of  the  existence 
of  cholera,  yellow  fever  or  small  pox  ;  be  it  Resolved — 

1.  That  it  is  the  sense  of  the  National  Conference  of  State  Boards  of 
Health,  that  it  is  the  duty  of  each  State  and  Provincial  Board  of  Health 
within  whose  jurisdiction  any  of  said  diseases  may  occur,  to  furnish  im¬ 
mediate  information  of  the  existence  of  such  disease  to  boards  of  health 
of  neighboring  States  and  Provinces,  and  to  local  boards  in  such  States 
as  have  no  central  board,  in  which  the  duty  of  notification  shall  lie  up¬ 
on  the  local  boards. 

2.  That  upon  the  prevalence  of  rumor  of  the  existence  of  pestilential 
disease  in  any  State  or  Province,  if  positive,  definite  information  there¬ 
on  be  not  obtainable  from  the  proper  health  authorities,  this  Conference 
holds  that  the  health  officials  of  another  State  are  justified  in  entering  the 
before-mentioned  State  or  Province  for  the  purpose  of  investigating  and 
establishing  the  truth  or  falsity  of  such  reports. 

3.  That  whenever  practicable,  the  investigations  undertaken  under 
the  preceding  section  shall  be  made  with  the  co-operation  of  the  State 
or  local  health  authorities. 

4.  That  any  case  which  presents  symptoms  leading  to  serious  suspi¬ 
cion  of  the  existence  of  one  of  the  aforenamed  diseases,  shall  be  treated 
as  suspicious,  and  reported  as  provided  for  in  cases  in  which  the  diag¬ 
nosis  is  certain. 

5.  That  any  case  respecting  which  reputable  and  experienced  physi¬ 
cians  disagree  as  to  whether  the  disease  is  or  is  not  pestilential,  shall 
be  reported  as  suspicious. 

6.  That  any  suspected  case  respecting  which  efforts  are  made  to  con¬ 
ceal  its  existence,  full  history,  and  true  nature,  shall  be  deemed  suspi¬ 
cious  and  so  reported. 

7.  That  in  accordance  with  the  provisions  of  the  foregoing  resolu¬ 
tions,  the  Boards  of  Health  of  the  United  States  and  Canada,  represen¬ 
ted  at  this  conference,  do  pledge  themselves  to  an  interchange  of  infor¬ 
mation  as  herein  provided. 

The  following  resolutions,  explanatory  of  the  above,  were 
adopted  by  the  International  Conference  of  State  Boards  of 
Health,  at  Washington,  September  8,  1887 : 

Resolved ,  That  the  conference  re-affirms  the  principles  contained 
in  the  resolutions  adopted  by  it  at  its  meeting  in  Toronto  in  1886, 


43 


2.  That  the  communicable  diseases  hereinafter  mentioned,  prevalent 
in  certain  areas,  or  which  tend  to  spread  along  certain  lines  of  travel, 
be  reported  to  all  State  and  Provincial  Boards  within  said  area  or  along 
said  line  of  communication. 

3.  That  in  the  instance  of  small-pox,  cholera,  yellow  fever  and  ty¬ 
phoid  fever,  reports  be  at  once  forwarded,  either  by  mail  or  telegraph, 
as  the  urgency  of  the  case  may  demand  ;  and  further,  that  in  the  in¬ 
stance  of  diphtheria,  scarlatina,  typhoid  fever,  anthrax  or  glanders, 
weekly  reports,  when  possible,  be  supplied,  in  which  shall  be  indicat¬ 
ed,  as  far  as  known,  the  places  implicated,  and  the  degree  of  prevalence. 


' 


■ 


APPENDIX. 

PAPERS  READ  BEFORE  THE 

MONTGOMERY 

QUARANTINE  CONFERENCE, 

1889. 


4 

.  . 


U)  v  ;  \  ll 


* 

•# 


APPENDIX  I. 


PROPOSITIONS  TO  BE  SUBMITTED  TO  THE  QUAR¬ 
ANTINE  CONFERENCE. 


PROPOSITIONS  SUBMITTED  BY  DR.  A.  N.  BELL,  OF  NEW  YORK. 

Every  organized  government,  State  or  local,  has  the  right 
of  protecting  itself  against  the  introduction  of  infectious  or 
contagious  diseases,  and,  to  this  end,  of  excluding  any  per¬ 
son  or  thing  and  of  prohibiting  communication  by  or  with 
any  country  or  place  deemed  likely  to  introduce  infectious 
or  contagious  diseases  of  any  kind  ;  Provided  however ,  that 
no  prohibitory  measures  should  go  so  far  as  to  exclude  or 
drive  from  port  any  infected  vessel ;  or  refuse  proper  care 
and  treatment  of  any  persons  who  are  afflicted  with  or  who 
have  been  exposed  to  an  infectious  disease,  no  matter  what 

may  be  its  nature. 

With  special  reference  to  yellow  fever  : 

A  filthy  vessel  from  any  place  where  yellow  fever  is  wont 
to  prevail,  or  that  is  in  habitual  communication  with  any 
such  place,  is  much  more  to  be  dreaded  as  a  vehicle  of  in¬ 
troducing  the  disease  than  any  person  or  thing  such  vessel 
may  have  on  board.  No  such  vessel,  whether  there  has 
been  recent  sickness  on  board  or  not,  and  no  matter  what 
the  condition  of  the  last  port  of  departure  of  any  such  ves¬ 
sel,  or  her  bill  of  health,  should,  in  the  summer  time  espe¬ 
cially,  be  allowed  admission  to  any  city  wharf,  or  to  lie 


alongside  any  other  ship  or  vessel,  until  broken  out  and 
thoroughly  cleansed,  and  all  the  cargo,  merchandise,  effects, 
ballast — material  and  personnel — of  such  vessels  are  more 
or  less  dangerous  and  should  be  treated  accordingly. 

All  vessels  should  be  visited  as  soon  as  practicable  after 
their  arrival,  always  within  twelve  hours  at  the  outside,  and 
subjected  to  examination  and  questioning  by  the  sanitary 
authority  of  the  port.  The  history  of  the  vessel  should  be 
particularly  inquired  into  with  reference  to  the  ports  she 
has  visited,  sickness  on  board  and  measures  to  which  she 
has  been  subjected,  if  any,  for  cleansing;  and  the  result  of 
such  examination  should  be  recorded  upon  a  special  register 
kept  for  the  purpose. 

All  persons  found  on  board  a  vessel  infected  with  yellow 
fever  who  have  not  had  and  fully  recovered  from  the  disease 
should  be  removed  therefrom  to  places  of  healthful  sur¬ 
roundings  as  soon  as  possible.  The  detention  of  the  sick 
in  infected  vessels  greatly  adds  to  the  danger  of  a  fatal 
issue  ;  and  every  hour’s  detention  of  the  well  in  any  infected 
vessel  or  place  adds  to  the  danger  of  contracting  the  dis¬ 
ease. 

Persons  who  have  been  exposed  to  yellow  fever  infection 
within  five  days  of  the  time  of  their  arrival  at  any  place 
with  an  average  temperature  of  70°  F.  or  upward,  should 
be  secluded  in  a  healthful  place,  and  required  to  divest 
themselves  completely  of  all  clothing  that  has  been  worn  on 
board  or  exposed  to  the  atmosphere  of  an  infected  ship,  or 
to  that  of  any  place  where  yellow  fever  existed  at  the  time, 
to  thoroughly  wash  themselves  and  substitute  clothing 
which  has  not  been  so  exposed,  before  admission  to  inter¬ 
course  with  the  inhabitants  of  the  place,  or  permission  to 
proceed  elsewhere.  These  requirements  being  fulfilled,  and 
they  should  always  be  as  soon  as  possible  after  arrival, 
there  is  no  danger  of  such  persons  propagating  the  disease, 
and  they  should  be  permitted  liberty. 

Personal  effects,  merchandise  and  ballast  which  have  been 
exposed  to  an  infected  ship  or  brought  from  an  infected 


49 


place,  are  more  or  less  dangerous,  according  to  the  nature 
of  the  substance.  Such  substances  may  be  enumerated,  ap¬ 
proximately,  in  the  order  of  their  greater  liability  to  propa¬ 
gate  infection,  as  follows  : 

Personal  clothing,  bedding,  rags,  paper  rags,  books  and 
papers,  hides,  skins,  feathers,  woolens,  hair,  and  all  other 
remains  of  animals,  porous  ballast,  silks,  cotton,  linen,  hard 
ballast. 


PROPOSITIONS  SUBMITTED  BY  DR.  JNO.  B.  HAMILTON,  SURGEON 
GENERAL  MARINE  HOSPITAL  SERVICE. 

Topic  1. — What  form  of  notification  shall  be  adopted  in 
case  of  occurrence  of  yellow  fever  ?  To  whom  shall  the 
first  notification  be  sent? 

Topic  2. — On  receiving  notice  of  existence  of  yellow  fever 
in  any  place,  is  it  desirable  that  the  Government  should 
send  an  inspector,  free  from  local  influences,  to  verify  ? 

Topic  3.  Under  what  circumstances  should  an  epidemic 
be  declared  to  exist? 

Topic  4.—  How  soon  should  we  advise  depopulation  in 
the  event  of  the  appearance  of  yellow  fever  in  any  place  ? 

Topic  5. — Is  it  practicable  to  cause  depopulation  of  large 
cities  ?  Is  it  necessary  to  secure  additional  legislation  to 
compel  persons  to  sojourn  in  camps  of  refuge  ? 

Topic  6. — Are  probation  camps  desirable  ?  By  whom 
should  they  be  managed  and  supported  ?  What  period  of 
time  should  elapse  from  the  time  of  arrival  at  camp  until 
the  granting  of  free  pratique  ?  Should  probation  camps 
have  separate  yellow  fever  camps?  Should  the  certificate 
of  the  officer  in  charge  of  the  probation  camp  entitle  a  per¬ 
son  to  enter  free  any  other  place  ? 

-  Topic  7. — Is  it  desirable  to  allow  special  trains  to  pass 

to  mountainous  regions,  comparatively  uninhabited  ? 

Topic  8. — On  the  occurrence  of  a  case  of  yellow  fever, 
what  immediate  measures  of  isolation  are  desirable  ?  What 
restriction  should  be  placed  on  physicians  in  attendance 

4 


50 


on  a  case  of  yellow  fever?  In  case  of  death,  what  disposi¬ 
tion  should  be  made  of  the  body? 

Topic  9. — What  means  of  disinfection  should  be  adopted 
for  chambers  and  dwellings  where  cases  of  yellow  fever  have 
occurred  ? 

Topic  10. — What  system  of  disinfection  should  be  adopted 
for  the  disinfection  of  personal  baggage  of  persons  fleeing 
from  an  infected  place  ? 

Topic  11. — Is  yellow  fever  contagious?  What  diagnostic 
signs  should  be  agreed  upon  as  reasonable  proof  of  the 
presence  of  yellow  fever?  What  post-mortem  evidences 
should  be  accepted  as  conclusive  that  the  person  died  of 
yellow  fever  ? 

PROPOSITIONS  SUBMITTED  BY  DR.  J.  N.  MCCORMACK,  SECRETARY 
OF  THE  KENTUCKY  STATE  BOARD  OF  HEALTH. 

Resolved :  (1)  That  it  is  the  sense  of  this  Convention  that 
all  ports  on  the  Gulf  coast,  and  all  on  the  Atlantic  coast 
south  of,  and  including  Charleston,  not  fully  equipped  for 
quarantine  administration,  in  accordance  with  the  most  ap¬ 
proved  modern  methods,  should  be  closed  against  vessels 
from  West  Indian  and  South  American  ports  from  the  first 
of  March  to  the  first  of  October  in  each  year. 

Resolved :  (2)  That  this  Convention  urges  upon  all  health 
authorities  of  States  represented  in  it  the  importance  of 
strict  compliance  with  the  agreement  of  inter-State  notifica¬ 
tion  adopted  by  the  National  Conference  of  State  Boards  of 
Health,  and  the  Sanitary  Council  of  the  Mississippi  Valley, 
in  regard  to  all  communicable  diseases,  and  especially  in 
regard  to  yellow  fever. 

Resolved  :  (3)  That  upon  the  outbreak  of  yellow  fever 

in  any  city  or  town,  this  convention  urges  such  co-opera¬ 
tion  in  quarantine  administration  on  the  part  of  threatened 
States  as  will  confine  the  disease  to  the  point  of  initial  at¬ 
tack,  in  place  of  the  expensive,  unscientific  and  unsatisfac¬ 
tory  so-called  quarantines  at  distant  State  lines. 

Resolved :  (4)  That  this  convention  urges  upon  the  health 


51 


authorities  of  each  State  the  importance  of  such  an  admin¬ 
istration  of  any  quarantine  they  may  establish  as  will  fur¬ 
nish  proper  protection  to,  and  show  due  regard  for  the 
rights  of  States  lying  beyond  them. 

PROPOSITIONS  IN  REGARD  TO  THE  QUARANTINE  OF  RAILROADS,  SUB¬ 
MITTED  BY  DR.  JEROME  COCHRAN,  STATE  HEALTH  OFFICER 

OF  ALABAMA. 

(1).  During  the  prevalence  of  yellow  fever  epidemics, 
passengers  and  freights  should  be  brought  from  infected 
localities  only  under  such  regulations  and  restrictions  as 
may  be  established  by  the  health  authorities  along  the 
lines  of  the  roads  concerned. 

(2.)  The  regulations  and  restrictions  governing  railroad 
transportation  during  yellow  fever  epidemics  should  be  of 
such  character  as  to  afford  all  reasonable  guarantees  of  pro¬ 
tection  to  the  communities  in  danger  of  invasion  by  the 
disease,  but  should  not  be  more  onerous  than  the  circum¬ 
stances  warrant,  and  should  be  framed  with  due  consider¬ 
ation  of  the  extent  and  character  of  the  danger  in  each  par¬ 
ticular  case,  and  as  affected  bv  latitude  and  seasons  of  the 
year,  and  other  qualifying  conditions. 

(3.)  At  all  seasons  of  the  year,  and  under  all  circumstan¬ 
ces,  the  simple  passage  of  railroad  trains  should  be  allowed, 
without  obstruction,  even  when  carrying  sick  refugees  from 
infected  places'to  healthy  localities  willing  to  receive  them. 

(4.)  When  the  transfer  of  passengers  or  freights  from  in¬ 
fected  localities  from  one  railroad  to  another  becomes  nec¬ 
essary,  such  transfers  should  be  done  under  such  precau¬ 
tions  as  may  be  deemed  necessary  by  the  health  authori¬ 
ties  of  the  places  at  which  the  transfers  are  made  ;  but  no 
restrictions  should  be  made  that  will  render  such  transfers 
impracticable,  and  transfers  of  passengers  and  freights  from 
places  not  infected  should  not  be  burdened  with  unnecessa¬ 
ry  restrictions.  Quarantines  against  all  the  world  are  il¬ 
legal,  mischievous,  and  in  every  way  unwarrantable. 

(5.)  Quarantine  inspectors  on  rail  road  trains  should  be 
under  the  control  of  the  health  authorities  of  the  several 


52 


States,  rather  than  under  the  control  of  the  health  author¬ 
ities  of  the  communities  scattered  along  the  line  of  the 
road.  In  this  way  quarantine  regulations  may  be  enforced 
with  the  smallest  amount  of  friction  and  inconvenience  to 
the  travelling  public  and  with  the  maximum  of  efficiency 
and  economy.  At  the  same  time  the  wishes  of  the  local 
authorities  should  be  treated  with  all  due  consideration. 

(6.  When  circumstances  require  it  the  States  should  es¬ 
tablish  quarantine  camps  at  such  places  as  may  be  most 
convenient  for  the  detention  of  travellers,  disinfection  of 
baggage,  and  treatment  of  the  sick.  It  is  barbarous  and 
inhuman  to  dump  off  travellers  of  any  sort,  and  especially 
women  and  children  and  the  sick,  on  the  side  of  the  road 
to  take  care  of  themselves  the  best  they  can. 


PROPOSITIONS  IN  REGARD  TO  THE  LOCAL  MANAGEMENT  OF  YEL¬ 
LOW  FEVER — SUBMITTED  BY  DR.  JEROME  COCHRAN,  STATE 
HEALTH  OFFICER  OF  ALABAMA. 

(1.)  When  one  case  or  a  few  cases  of  yellow  fever  occur  in 
any  community,  it  does  not  follow  of  necessity  that  the  dis¬ 
ease  must  spread  and  become  epidemic.  On  the  contrary, 
the  experience  of  many  countries  through  long  periods  of 
time  shows  conclusively  that  in  the  majority  of  such  in¬ 
stances  and  without  the  observance  of  any  special  means  of 
prophylaxis,  the  disease  fails  to  spread. 

(2.)  When  one  case  of  a  few  cases  of  yellow  fever  occur 
in  any  community,  in  the  light  of  our  present  knowledge 
of  the  habits  and  modes  of  propagation  of  the  disease,  it  is 
generally  possible,  by  the  employment  of  the  proper  pro¬ 
phylactic  measures  to  prevent  the  development  of  an  epi¬ 
demic. 

NON-INTERCOURSE. 

(3.)  The  golden  rule  for  the  prevention  of  the  spread  of 
yellow  fever  is  non-intercourse — isolation — the  keeping  of 
the  well  away  from  the  sick,  away  from  infected  things,  and 
very  specially  away  from  infected  localities. 

(4.)  In  the  enforcement  of  this  golden  rule  of  non-inter- 


53 


course  two  problems  present  themselves  for  solution,  (a) 
To  keep  the  people  generally  from  coming  into  the  infected 
houses  and  the  infected  localities  ;  and  (b)  To  keep  doctors 
and  nurses  and  other  attendants  and  the  well  members  of 
,  sick  families  from  visiting  and  mingling  with  people  outside 

f  of  the  infected  houses  and  localities.  The  solution  of  the 

first  of  these  problems  is  comparatively  easy.  The  solution 
of  the  second  is  sufficiently  difficult.  But  it  is  possible  to 
solve  them  both. 

(5.)  In  the  densely  settled  sections  of  cities  guards  may 
be  useful  for  the  enforcement  of  non-intercourse.  They 
are  much  less  needed  in  sparsely  settled  towns.  In  villa¬ 
ges  and  country  neighborhoods,  as  a  rule,  they  are  not  need¬ 
ed  at  all.  In  all  cases  every  intelligent  family  should  be 
able  to  take  care  of  itself — should  be  able  to  keep  all  of  its 
members  away  from  infected  houses  and  localities,  and  to 
guard  its  own  premises  from  invasion  by  dangerous  persons 
and  things. 

(6.)  Non-intercouse  may  be  practiced  in  the  very  centre 
of  an  infected  district  with  considerable  probability  of  es¬ 
caping  the  fever.  Cloistered  convents  and  prisons  in  in¬ 
fected  cities,  with  yellow  fever  raging  all  around  them, 
usually  escape  invasion  ;  and  there  are  numerous  instances 
on  record  in  which  private  families  in  the  midst  of  epidem¬ 
ics  have  passed  the  ordeal  safely  by  the  vigorous  enforce¬ 
ment  of  non-intercourse. 

DISINFECTION. 

v*  (7.)  Disinfection  in  yellow  fever  is  based  very  largely  on 

theoretical  grounds.  Nevertheless,  we  believe  that  it  may 
be  made  a  valuable  agent  in  checking  the  spread  of  the 
disease.  In  the  beginning  of  an  outbreak  all  the  resources 
of  disinfection  should  be  exhausted,  and  these  efforts  should 
be  continued  until  the  epidemic  is  fully  established.  After 
the  epidemic  has  subsided  disinfection  is  of  very  question¬ 
able  value. 

(8.)  The  disinfecting  agents  most  to  be  trusted  are  heat, 


54 


especially  moist  heat,  cold,  both  artificial  and  natural,  and 
especially  cold  weather  and  frost ;  and  certain  chemicals, 
especially  the  bichloride  of  mercury  and  the  fumes  of  burn¬ 
ing  sulphur.  To  these  must  be  added  ventilation. 

(9.)  The  disinfection  of  beds,  bedding,  clothing,  and  arti¬ 
cles  of  similar  character  is  comparatively  easy.  The  disin¬ 
fection  of  single  rooms,  and  perhaps,  also,  of  single  houses, 
is  more  difficult  but  not  entirely  impracticable.  The  dis¬ 
infection  of  yards  must  be  regarded  as  very  difficult,  but 
in  the  beginning  of  an  outbreak  it  should  be  attempted.  The 
disinfection  of  a  whole  city,  or  even  of  a  large  section  of  a 
city,  seems  not  to  be  practicable. 

\ 

DEPOPULATION. 

(10)  In  the  beginning  of  an  outbreak  of  yellow  fever  there 
is  no  need  of  depopulation  at  all,  except  of  infected  houses,  or 
infected  districts ;  but  if  people  who  are  able  to  afford  the  ex¬ 
pense  desire  to  leave  they  should  do  so  quietly  and  deliberately, 
and  no  obstacles  should  be  placed  in  their  way ;  and  those  who 
leave  healthy  districts  of  the  city  or  town  should  go  wherever 
they  please,  without  let  or  hindrance. 

(11)  Persons  living  in  infected  houses,  or  in  infected  dis¬ 
tricts,  should  be  encouraged  to  leave,  but  should  be  allowed  to 
leave  only  under  such  restrictions  as  will  afford  reasonable 
guarantees  of  safety  to  the  communities  in  which  they  find  asy¬ 
lum  ;  and  they  should  be  sent  only  to  such  communities  as  are 
willing  to  receive  them. 

(12)  In  the  depopulation  of  infected  houses,  or  of  special 
infected  districts,  the  inhabitants  should  be  removed  into  camps 
of  probation,  or  into  vacant  houses  in  the  adjacent  country. 
After  five  days  detention,  if  they  remain  well,  and  under 
proper  regulations,  such  as  disinfection  of  baggage,  they  should 
be  considered  free  from  danger,  and  allowed  to  go  freely  into 
any  community  willing  to  receive  them. 

(13)  The  depopulation  of  large  cities  is  altogether  imprac¬ 
ticable.  The  depopulation  of  sparsely  settled  towns  and  vil¬ 
lages  is  altogether  unnecessary,  as  in  them  it  is  always  possible 
to  prevent  any  general  spread  of  the  fever. 


55 


(14)  Refuge  camps,  that  is  to  say,  camps  for  the  continued 
residence  of  people  during  the  prevalence  of  epidemics,  have 
heretofore  been  of  small  value.  One  reason  for  this  is  that  it 
is  never  possible  to  induce  any  considerable  proportion  of  the 
population  of  an  infected  city  to  take  refuge  in  the  camps. 
Camps  of  probation,  for  temporary  detention,  may  often  be 
very  useful. 

(15)  Panics  and  stampedes  are  always  without  excuse  and 
at  the  same  time  excessively  mischievous.  At  the  beginning 
yellow  fever  always  spreads  slowly ;  and  there  is  always  time 
for  every  body  who  desires  to  leave  an  infected  place  to  do  so 
without  hurry  and  under  proper  regulations. 

SHOT  GUN  QUARANTINES. 

(16)  Shot  gun  quarantines  are  barbarous,  and  discreditable 
to  our  civilization.  All  quarantines  should  be  under  the  con¬ 
trol  of  experts. 

HEALTH  CERTIFICATES.  . 

(17)  Health  certificates  should  be  required  only  in  the  case 
of  persons  leaving  an  infected  place.  They  should  be  issued 
only  by  the  health  official  in  charge  of  the  infected  place.  In 
each  certificate  the  person  to  whom  it  is  issued  should  be  so 
described  as  to  admit  of  his  identification,  and  should  state  the 
facts  of  the  case  fully  and  circumstantially.  And  to  such  cer¬ 
tificates  full  credence  should  be  given  by  all  health  authorities. 
We  must  have  honesty  and  mutual  confidence  amongst  those 
charged  with  the  protection  of  the  public  health. 

PLACES  OF  REFUGE. 

(18)  Under  proper  regulations  refugees  from  infected  places 
may  be  allowed  to  go  anywhere  without  danger  of  carrying 
infection  with  them,  and  should  generally  be  allowed  to  do  so. 
Still,  it  is  better  that  they  should  go  to  cooler  and  more  north¬ 
erly  climates,  and  into  states  and  cities  not  ordinarily  subject 
to  yellow  fever.  In  regard  to  this  matter,  a  great  deal  depends 


56 


on  the  season  of  the  year.  In  June  or  July  precautions  may 
be  wise  that  would  be  entirely  unnecessary  in  September  or 
October. 


WHEN  REFUGEES  MAY  RETURN. 

(19)  In  most  of  our  southern  communities  refugees  from  an 
infected  place  may  return  safely  after  the  appearance  of  a  kill¬ 
ing  frost.  In  the  present  state  of  our  knowledge  it  is  not  pos¬ 
sible  to  say  whether  or  not  frost  kills  the  yellow  fever  poison, 
but  the  experience  of  many  hundreds  of  epidemics  shows  be¬ 
yond  all  controversy  that  it  puts  an  end  to  the  prevalence  of 
the  fever. 

(20)  Even  in  places  where  no  frost  is  ever  known,  experi¬ 
ence  teaches  that  after  the  subsidence  of  the  fever  for  a  reason¬ 
able  time,  there  is  no  longer  any  danger.  When  the  fever  dis¬ 
appears  the  danger  of  contracting  the  fever  disappears  also. 

HIBERNATION. 

(21)  In  the  extreme  southern  parts  of  our  country,  and  in 
very  mild  winters,  it  is  possible  for  yellow  fever  to  live  through 
the  winter  months  and  to  become  epidemic  again  on  the  advent 
of  the  following  summer.  But  in  all  such  instances  it  is  kept 
alive  by  the  occasional  occurrence  of  scattered  cases — cases 
springing  up  here  and  there  at  intervals  of  only  a  few  weeks. 
It  does  not  hibernate  in  any  other  way  than  this.  It  never 
goes  to  sleep  when  the  cold  weather  comes  in  the  autumn,  to 
sleep  for  three,  four  or  six  months,  and  to  be  awakened  into 
malignant  life  when  the  hot  weather  comes  the  next  summer. 

FINANCIAL  MANAGEMENT. 

(22)  In  yellow  fever  epidemics,  as  under  other  circum¬ 
stances,  all  self-respecting  persons  and  all  self-respecting  com¬ 
munities  should  pay  their  own  expenses,  and  take  care  of  them¬ 
selves  just  as  long  as  they  are  able  to  do  so,  and  the  aid  of 
public  charity  should  be  invoked  only  in  cases  of  real  neces¬ 
sity. 


57 


(23)  In  yellow  fever  epidemics  physicians  should  make 
their  regular  charges,  just  as  in  the  treatment  of  other  diseases, 
against  all  persons  who  are  able  to  pay  ;  and  neither  physicians, 
nor  medicines,  nor  nurses,  nor  provisions,  nor  assistance  of  any 

,  kind  should  be  furnished  at  the  public  expense  to  any  persons 
^  except  those  who  are  really  in  indigent  circumstances.  To 

help  those  who  are  able  to  help  themselves  is  an  abuse  of  pub- 
4  lie  charity. 

(24)  The  administration  of  the  quarantine  laws  should 
always  be  under  the  direction  of  the  legally  constituted  health 
authorities  of  the  community  to  be  protected.  The  health 
authorities  may  make  mistakes,  but  they  will  make  fewer  mis¬ 
takes  than  the  political  authorities  will  make.  As  quarantines 
are  at  present  conducted  in  many  of  the  states,  the  aggregate 
of  quarantine  expenses  is  much  greater  than  there  is  any  neces¬ 
sity  for. 

(25)  The  quarantine  of  small  towns  is  a  very  simple  prob¬ 
lem,  and  may  be  managed  without  much  expense.  As  the 
population  increases  the  problem  becomes  more  and  more  diffi¬ 
cult  ;  and  in  very  large  cities  it  requires  for  its  wise  solution 
the  highest  expert  skill,  and  abundant  means. 

(26)  There  are  two  sorts  of  quarantine  fundamentally  dis¬ 
tinct — the  police  quarantine  and  the  scientific  quarantine.  The 
purpose  of  the  police  quarantine  is  to  exclude  everything  com¬ 
ing  from  the  infected  locality.  The  purpose  of  the  scientific 
quarantine  is  to  exclude  only  such  things  as  are  dangerous. 
Very  often,  especially  for  the  protection  of  small  communities, 
the  police  quarantine  is  the  only  one  that  is  available.  But  as 

-  far  as  circumstances  will  admit  of  it,  the  scientific  quarantine 

under  the  management  of  quarantine  experts,  should  always 
be  preferred. 

(27)  Local  quarantines,  that  is  to  say  the  separate  quarantine 
of  towns  and  counties  should,  as  far  as  circumstances  will  war¬ 
rant,  be  superseded  by  state  quarantines,  and  this  on  the 
grounds  alike  of  economy,  efficiency  and  convenience.. 


APPENDIX  II. 


MARITIME  QUARANTINE  SERVICES  OF  THE 
SOUTHERN  SEA  PORTS. 


The  quarantine  systems  of  the  Southern  Atlantic  and 
Mexican  Gulf  Ports  of  the  United  States  is  a  matter  of 
paramount  interest  to  the  members  of  this  conference  ;  the 
health,  prosperity  and  happiness  of  our  people  being  inti¬ 
mately  connected  with  the  management  of  preventive 
measures  against  the  introduction  of  contagious  disease. 

The  means  of  rapid  communication  between  points  in  our 
country,  the  extensive  trade  enjoyed  by  the  different  cities 
with  each  other,  the  constant  arrival  of  travellers,  on  busi¬ 
ness  or  pleasure  bent,  from  one  place  to  another,  wipe  out 
the  imaginary  geographical  lines  and  unite  the  vast  field 
into  one  common  whole;  the  people  possessed  with  kindred 
interests,  sharing  mutual  joys,  and  facing  mutual  dangers, 
even  though  a  local  disaster  may  threaten  not  the  well 
being  of  other  neighboring  communities,  it  never  fails  to 
excite  the  warmest  sympathy  ;  and  generous  and  substantial 
aid  is  never  wanting  to  the  unfortunate.  When  at  any  time, 
however,  the  calamity  befalling  one  involves  and  threatens 
devastation  to  other  points,  the  means  by  which  such  evil 
has  happened,  becomes  the  subject  of  proper  community  in¬ 
quiry,  and  measures  for  prevention  of  the  repetition  of  such 
peril  are  made  the  one  common  care  of  all.  Indeed,  from  a 
property  standpoint  the  commercial  damage  inflicted  by  the 
appearance  of  yellow  fever  at  one  place  in  the  South  cannot 
be  limited  to  that  point.  Commercial  apprehension  of  the 
spread  of  the  disease  to  other  towns  must  necessarily 
follow,  and  the  commercial  credit  of  the  whole  country  is  to 
that  extent  impaired,  and  so  one  common  danger — one 


59 


common  interest  cannot  fail  to  make  of  us  co-workers  in 
one  common  cause. 

The  history  of  yellow  fever  epidemics  of  this  country  re¬ 
veals  the  fact  that  the  largest  number  prevailed  at  the  time 
of  greatest  and  most  unrestricted  tropical  traffic.  At  one 
time  the  disease  appeared  annually  at  every  sea  port,  from 
Portland,  Maine  to  New  Orleans,  the  extent  and  malignancy 
of  the  scourge  varying  in  different  years.  On  the  cessation 
of  this  traffic,  by  compulsion  under  the  edicts  of  parliament 
in  1762,  until  the  close  of  the  Revolutionary  War,  the 
occurrence  of  yellow  fever  ceased  at  those  ports  affected  by 
the  edicts,  to  reappear  on  the  resumption  of  trade,  to  disap¬ 
pear  again  on  cessation  of  foreign  trade  under  acts  of  Con¬ 
gress  1809  to  1811,  and  the  war  of  1812  to  1815,  and  to  re¬ 
appear  again  when  trade  was  again  revived.  Quarantine 
restrictions  were  very  soon  thereafter  imposed  at  the  larger 
ports  which  had  absorbed  the  foreign  business  of  neighbor¬ 
ing  smaller  ones,  with  varying  but  progressive  successes 
until  the  usefulness  of  that  institution  has  long  been  fully 
demonstrated.  Difference  in  quarantine  rules  necessary  for 
safety  have  not  heretofore  been  caused  by  geographical  and 
climatic  conditions  alone.  Selfish  interests  largely  domi¬ 
nated;  commercial  influences  shaped  the  measures  of  re¬ 
striction  ;  personal  gain  to  a  great  degree  controlled  the 
actions  of  many  men,  and  that  form  of  quarantine  least  in 
cost — least  in  obstruction  to  the  individual  was  strenuously 
advocated  as  the  best  by  those  pecuniarily  interested.  The 
'histor}'  of  quarantine  at  New  Orleans  illustrates  this  aptly. 
The  city  being  at  one  time  purely  commercial,  that  which 
would  interfere  with  its  Marine  was  forcibly  resisted — the 
inhabitants  engaged  in  a  fierce  party  war — the  importa- 
tionists  were  overcome  by  those  holding  the  doctrine  of 
local  origin,  and  thus  exemption  from  the  disease,  at  this 
port,  was  delayed  for  years. 

The  quarantine  systems  of  our  country  may  be  briefly 
classed  into  two  divisions; 


60 


First: — Those  imposing  prohibition  of  tropical  trade 
during  the  warm  months  of  the  year,  and — 

Second: — Those  providing  some  form  of  disinfecting 
appliances,  conjoining  with  the  operation  of  these  detentions 
in  quarantine  of  all  vessels  arriving  at  their  ports  engaged 
in  such  tropical  trade.  The  first  secure  protection  at  the 
cost  of  a  certain  portion  of  commerce,  and  the  second,  when 
sufficient,  secure  protection  with  but  slight  maritime  em¬ 
barrassment.  If  not  sufficient,  safety  is  not  obtained  and  all 
commerce  soon  becomes  lost. 

Public  inquiry  into  the  manner  of  administration  of  the 
various  quarantine  services  at  the  sea  ports  of  our  country 
has  never  been  seriously  undertaken,  prior  to  this  date,  ex¬ 
cept  in  two  instances — one  in  the  methods  in  use  at  New 
Orleans  subsequent  to  the  yellow  fever  epidemic  in  1878; 
and  the  other,  those  of  New  York  on  the  arrival  at  that 
port  two  years  ago,  of  the  cholera  infected  ship  Alesia. 
That  the  recent  epidemic  in  Florida  has  given  a  new  impetus 
to  every  properly  interested  person  to  make  necessary  in¬ 
vestigation  into  the  subject  is  apparent,  and  the  permanent 
organization  of  a  qualified  board  of  inquiry,  depending  for 
its  authority  upon  community  of  interests,  and  the  unwrit¬ 
ten  law  of  public  opinion,  is  now  a  foregone  conclusion, 
should  the  necessity  not  be  provided  for  by  national  legis¬ 
lation.  The  measures  of  disinfection  adopted  at  all  of  the 
quarantine  stations  in  the  United  States  except  that  of 
New  Orleans,  and  in  a  minor  degree  that  of  New  York,  consist 
in  fumigation  of  vessel  and  effects  with  sulphur  dioxide;, 
use  of  solutions  of  copperas,  carbolic  acid  or  mercuric 
chloride  over  the  ballast  and  in  the  bilges,  and  in  some 
instances  whitewashing  the  interior  of  ships  with  calcium 
oxide,  an  additional  measure  of  safety — detention  in  quar¬ 
antine  more  or  less  short  or  long  being  imposed. 

At  New  York  chloride  has  occasionally  been  substituted 
for  sulphur  dioxide,  and,  by  help  of  a  little  machine,  baled 
rags  are  heated  two  or  three  inches  from  the  channel  of 
entrance  of  a  pipe  discharging  super-heated  steam, 


61 


The  value  of  methods  of  disinfection  may  be  obtained  by 
colaborating  the  experiments  of  chemists  and  those  of 
practical  every  day  use.  Of  the  former  the  comprehensive 
report  of  the  committee  on  disinfectants  made  to  the  Amer¬ 
ican  Public  Health  Association  at  its  meeting  held  in  Mem¬ 
phis  in  1886,  is  most  instructive.  Of  the  latter  the  indi¬ 
vidual  experience  of  disinfecting  officers  is  of  considerable 
practical  weight. 

The  committee  referred  to  assigned  a  low  place  to 
sulphur  dioxide  as  a  germicidal  agent  in  non-spore  bearing 
nicro-organisms,  denied  it  a  position  for  those  bearing 
spores,  and  recommended  its  use  in  so  much  larger  per¬ 
centages,  and  for  so  much  longer  time  than  had  been  cus¬ 
tomary,  as  to  lead  to  candid  conviction  that  rarely  had  any 
beneficial  effect  ever  been  obtained  by  its  use  at  any  quar¬ 
antine  station.  Disinfection  of  premises  where  had  oc¬ 
curred  cases  of  contagious  disease,  sulphur  dioxide  fumi¬ 
gation  forming  part  of  the  process,  from  the  reports  of 
sanitary  officers  from  various  sections  of  the  country  appears 
to  be  of  great  value,  but  the  individual  part  played  by 
fumes  of  sulphur  in  the  good  work  has  not  as  yet  been  ac¬ 
curately  assigned.  The  experience  acquired  by  the  officers 
of  the  New  Orleans  quarantine  service,  after  use  of  the 
agent  in  a  manner  as  thorough  as  usually  obtained  at  other 
places,  shows  repeatedly  that  cases  of  yellow  fever  appeared 
on  vessels  which  had  been  subjected  to  its  employment. 
Other  places  present  like  testimony  as  to  the  sometimes 
inefficacy  of  this  germicide.  In  a  series  of  experiments 
conducted  by  Assistant  Surgeon  J.  J.  Kingyoun,  at  the  New 
Orleans  quarantine  station — to  which  duty  he  was  kindly  de¬ 
tailed  by  Surgeon-General  Hamilton — he  demonstrated  that 
in  the  customary  fumigation  of  vessels,  although  the  per¬ 
centage  of  gas  obtained  there  by  means  of  furnace  and 
steam  fan  was  greater  than  that  from  the  old  custom  of 
burning  in  iron  pots,  no  considerable  number  of  classes  of 
micro-organisms  were  killed.  His  experiments  were  not 
conducted  with  intent  to  ascertain  the  requisite  percentage 


62 


of  gas,  and  time  of  exposure  necessary  to  destroy  a  partic¬ 
ular  class,  but  to  determine  the  actual  value  of  usual  every 
day  fumigation  of  vessels.  The  result  revealed  that  sulphur 
fumigation  alone  usually  practiced  at  any  and  all  quaran¬ 
tine  stations  is  most  probably  of  very  little. 

After  prolonged  fumigation  of  rooms  with  dense  fumes  of 
sulphur,  it  is  usual  to  notice  a  large  number  of  dead  insects, 
but  close  observation  will  show  a  certain  proportion  of  live 
ones.  The  fumigation  of  baggage  at  the  Waycross  station 
during  the  past  summer  was  certainly  as  thorough  as  that 
practiced  at  any  quarantine  station,  and  yet  in  a  letter  to  me 
from  a  gentleman  at  that  place,  he  states  it  did  not  kill  body 
lice.  Not  any  number  of  negative  facts  that  yellow  fever  has 
not  appeared  on  vessels  from  infected  regions  subsequent  to 
fumigation  by  sulphur  will  destroy  the  potency  of  one  positive 
fact  that  it  has  so  appeared,  and  of  the  latter  there  are  many 
instances  on  record.  Practical  experience,  therefore,  warrants 
the  belief  that  the  special  cause  or  poison  of  yellow  fever  is  not 
always  destroyed  by  exposure  to  sulphur  dioxide  in  the  man¬ 
ner  hitherto  practiced. 

The  relative  utility  of  mercuric  chloride,  carbolic  acid, 
chlorine,  and  lime  is  so  clearly  and  ably  set  forth  in  the  report 
of  the  committee  above  mentioned  that  I  will  refer  my  listen¬ 
ers  to  the  pages  of  the  proceedings  of  American  Public  Asso¬ 
ciation  for  1886. 

The  time  of  detention  in  quarantine  is  a  matter  of  consider¬ 
able  consideration,  an  unnecessary  detention  is  a  matter  of  cost 
and  inconvenience  to  vessels,  and  to  that  extent  is  an  embar¬ 
rassment  to  commerce.  At  most  of  the  quarantines  the  time 
varies  from  ten  to  forty  days.  The  value  of  this  portion  of 
the  quarantine  service  is  sufficient  or  insufficient  whether  after 
or  before  disinfection  of  vessels.  Referring  only  to  the  imme¬ 
diate  past,  a  vessel  from  Havana  lay  twenty-one  days  at  the 
Pensacola  quarantine,  at  the  expiration  of  that  time  went  on  to 
the  wharves  of  the  city  ;  among  the  men  who  began  loading 
her  yellow  fever  appeared,  and  an  epidemic  followed.  A  ves¬ 
sel  forty-two  days  on  the  voyage  from  Rio  Janeiro  lay  an  ad- 


63 


ditional  ten  days  at  the  New  Orleans  quarantine,  three  dajrs 
after  leaving,  making  a  total  detention,  one  may  say,  of  fifty- 
five  days,  two  of  the  crew  were  attacked  with  the  disease. 
Each  of  these  vessels  presented  absolutely  clean  health  records. 
Will  a  detention  of  ten  days  be  sufficient  in  a  case  similar  to 
the  one  at  Pensacola,  or  will  one  of  forty  days  guard  against 
danger  from  one  like  that  at  New  Orleans  ?  After  three  sue- 
cessive  seasons  of  sufficient  disinfection  of  vessels  at  New 
Orleans  the  period  of  detention  has  never  exceeded  five  days 
thereafter,  and  I  have  every  reason  to  believe  that  this  may  be 
safely  reduced  to  three,  but  invariably  dating  the  hour  of 
commencing  detention  from  the  time  of  completed  disinfec¬ 
tion. 

Lengthy  voyages  and  long  periods  of  detention  in  quaran¬ 
tine  remove  no  source  of  danger,  but  on  the  contrary  are  full 
of  peril  to  an  over  confident  community.  The  form  of  quar¬ 
antine  service  compatible  with  safety  to  those  parts  which  do 
not  possess  sufficient  tropical  trade  to  justify  expensive  and 
properly  equipped  sanitary  apparatus  may  be  inexpensively 
obtained,  if  operated  in  conjunction  with  those  quarantine 
stations  now  and  about  to  be  established  by  the  National  Gov¬ 
ernment.  Let  these  be  considered  as  stations  for  the  treat¬ 
ment  of  vessels  then  and  recently  infected,  and  the  local  sta¬ 
tions  for  the  cleansing  and  observation  of  vessels  with  clean 
health  record  from  suspected  or  infected  ports.  Not  every 
vessel  from  contaminated  ports  is  dangerous,  but  the  possibility 
of  positively  determining  its  true  character  exists  in  nearly 
every  instance.  Observation  of  the  records  of  vessels  mani¬ 
festing  infection  at  the  port  of  entrance,  after  having  been 
free  from  disease  during  the  voyage  and  at  the  port  of  depart¬ 
ure,  will  invariably  show  that  such  manifestation  has  occurred 
among  the  laborers  who  first  went  on  board  and  engaged  in 
shifting  ballast  and  cleaning  holds,  or  among  the  sailors  who 
got  out  from  the  depths  of  their  bags  and  boxes  articles  which 
had  been  packed  away  while  in  an  infected  atmosphere  and  not 
since  disturbed.  Infection,  whether  conveyed  thousands  of 
miles  by  sea,  during  hundreds  of  days,  at  the  bottom  of  a 


64 


sailor’s  bag,  is  as  highly  dangerous  as  that  brought  in  a  closed 
carpet  sack,  in  as  many  hours,  on  a  railroad  car  by  land.  Un¬ 
packing  of  all  goods,  shifting  of  ballast,  cleaning  up  holds  and 
all  nooks  and  corners,  pumping  out  bilge  water,  removal  of 
boards  along  each  side  of  the  keelson,  the  accumulated  filth 
taken  out,  and  all  of  that  work  necessary  to  put  a  vessel  in  a 
perfectly  cleanly  and  well  ventilated  condition  being  done, 
will,  in  the  vast  majority  of  instances,  cause  any  existing  lurk¬ 
ing  infection  to  declare  itself  in  the  illness  of  some  of  those 
engaged  in  such  labor.  Usually  this  work  is  done  at  the 
wharves  of  the  port  of  entrance,  and  usually  at  this  time  the 
seeds  of  a  devastating  disease  are  sown  amongst  the  inhabi¬ 
tants. 

The  question  may  be  asked  whether  this  work  had  not  best 
be  done  by  acclimated  men.  The  fact  that  at  few  ports  can 
acclimated  men  be  found  is  the  answer.  If  possible,  to  make 
assurance  doubly  sure,  disinfection  of  everything  on  board 
should  be  practiced.  By  means  of  a  pump  worked  by  two 
men,  and  sufficient  leads  of  hose,  solutions  of  chemical  disin¬ 
fectants  can  be  thrown  to  all  parts  of  the  vessel.  Should 
sulphur  fumigation  be  decided  upon  all  textile  fabrics  should 
be  carried  into  the  holds  and  hung  loosely  and  separately  upon 
ropes  stretched  across.  Either  the  liquified  anhydrous  sulphur 

dioxide  confined  in  iron  flasks  and  liberated  bv  means  of  screw 

«/ 

cocks,  or  a  simple  inexpensive  reverberating  furnace,  loaded 
with  three  pounds  of  sulphur  to  every  thousand  cubic  feet  of 
space  to  be  disinfected  should  be  fired  and  lowered  into  the 
holds,  the  hatches  and  all  other  openings  tightly  closed,  and 
the  fumigation  proceeded  with  for  at  least  twelve  consecutive 
hours.  Thorough  ventilation  of  every  part  of  the  vessel  should 
have  been  obtained  by  wind-sails  or  other  means,  and  a  certain 
amount  of  moisture  left  in  the  holds  for  greater  efficiency  of 
sulphur  fumigation.  If  at  the  expiration  of  the  five  days  after 
such  cleaning  and  disinfection,  no  case  of  yellow  fever  appears 
amongst  the  crew  of  a  vessel  so  managed  and  treated  she  may 
be  safely  considered  harmless  to  any  community.  Liquified 
anhydrous  sulphur  dioxide  will  probably  very  soon  take  the 


65 


”> 


5 


place  of  the  gas  obtained  by  burning  sulphur  in  furnaces. 
This  article,  liquified  under  pressure,  is  manufactured  in  this 
country,  but  the  cost  here  is  about  $65.00  per  hundred 
pounds.  At  the  works  of  a  zinc  factory  near  Oberhausser, 
Germany,  the  gas  will  be  placed  on  cars  in  suitable,  safe,  and 
conveniently  handled  flasks,  or  retorts,  for  $4.00  per  hundred, 
or  about  the  cost  of  that  weight  of  rolled  sulphur  itself.  As 
it  is  easily  transferred  from  a  large  to  smaller  receptacles,  and 
the  cost  in  bulk  is  much  less  than  in  package,  considerable 
economy  may  be  practiced  by  importing  in  large  retorts.  It 
volatilizes  to  about  2700  times  its  original  bulk  after  being 
liberated,  and  this  property  adapts  it  particularly  for  use  on 
vessels  with  cargo.  Certainty  in  percentage  to  contained  at¬ 
mosphere  is  another  recommendation.  An  experiment  will 
most  probably  be  made  with  it  the  coming  summer,  and  if  so, 
and  permission  can  be  obtained  from  Surgeon-General  Hamil¬ 
ton,  the  result  will  be  published  in  the  Weekly  Abstracts  of  Re¬ 
ports  of  the  Marine  Hospital  Service.  The  treatment  neces¬ 
sary  for  actually  infected  vessels  will  require  an  apparatus 
more  costly  than  the  limited  tropical  commerce  of  many  of 
our  ports  would  justify.  Through  the  liberality  of  the  Gen¬ 
eral  Government  some  stations  of  this  character  are  already 
established  and  others  soon  will  be,  and  to  these  stations  should 
be  sent  all  infected  vessels  which  arrive  at  ports  whose  quaran¬ 
tine  service  is  not  properly  equipped  for  the  treatment  neces¬ 
sary.  Of  all  the  quarantine  systems  which  treat  actually  in¬ 
fected  vessels,  that  at  Hew  Orleans  is  most  assuredly  the  best. 
The  institution  of  the  system  is  due  to  the  intelligence  and 
untiring  labor  of  Joseph  Holt,  M.  D.,  who,  after  much  opposi¬ 
tion,  and  much  unfavorable  criticism,  succeeded  in  establishing 
methods  ensuring,  when  properly  administered,  entire  safety 
from  danger  of  yellow  fever,  at  the  same  time  disembarrassing 
trade  of  hurtful  restrictions.  The  success  which  this  man 
achieved,  disenthralling  Hew  Orleans  from  the  annual  sway  of 
yellow  fever  and  permitting  opportunities  for  the  indefinite 
extension  of  her  commerce  and  manufactures,  entitles  him  to 
the  admiration  and  gratitude  of  his  fellow  men,  and  to  a  dis- 


5 


66 


tinguished  place  in  the  foremost  rank  of  philanthropic  sanita¬ 
rians.  Descriptions  of  this  system  have  been  so  often,  and  so 
widely  published,  that  full  particulars  are  now  unnecessary. 

The  experiments  conducted  by  Assistant  Kinyoun  at  this 
station  last  April  showed,  however,  that  pre-eminent  as  its 
success  had  been,  in  protecting  the  country  from  the  intro¬ 
duction  beyond  its  limits  of  even  one  case  of  yellow  fever, 
certain  improvements  to  reach  scientifically  positive  germi¬ 
cidal  effect  in  all  classes  of  known  pathogenic  micro-organ¬ 
isms  were  necessarj^.  In  order  to  reach  this  result  the 
board  of  health  of  Louisiana  decided  upon  the  erection  of 
cylindrical  heating  chambers,  8  feet  in  diameter  and  50  feet 
long,  built  of  steel,  and  capable  of  safely  bearing  15  lbs. 
working  pressure  to  the  square  inch.  These  chambers  are 
provided  with  tightly  fitting  heads,  steam  coils  and  jets, 
guages,  thermometers,  blowoffs,  suspended  rail  tracks,  and 
racks  on  which  to  hang  all  textile  fabrics.  Although  not 
as  yet  completed,  the  contractors  guarantee  250  degrees  dry 
or  moist  heat,  can  be  attained  in  them  within  30  minutes. 
The  application  of  a  lower  temperature  than  this,  230  to  212 
degrees  under  pressure,  ensuring  uniformity  of  temperature 
throughout  the  matter  to  be  disinfected,  will  fulfill  the  high¬ 
est  expectancy  of  success,  and  every  requirement  of  the 
best  practicable  disinfectant  recommended  by  that  high 
authority,  the  committee  on  disinfectants  of  the  American 
Public  Health  Association.  By  way  of  parenthesis  I  will 
state  that  this  form  of  apparatus,  mounted  on  platform 
cars,  was  urgently  recommended  to  the  Surgeon  General  of 
the  Marine  Hospital  Service  early  last  summer  for  use  at 
the  outlets  from  Florida.  I  have  assurances  that  if  the  na¬ 
tional  government  does  not  adopt  this  or  some  other  good 
process  for  inland  use,  such  will  be  built  by  private  sub¬ 
scription,  and  placed  in  the  hands  of  local  authorities  at 
points  of  egress,  from  any  place  which  may  in  the  future 
become  infected.  With  the  addition  of  elevated  tanks  from 
which  solution  of  mercuric  chloride  may  be  thrown  over 
every  portion  of  the  interior  of  vessels,  steam  fans  for 


67 


changing  atmosphere  of  holds  and  replacing  it  by  one 
charged  with  sulphur  dioxide,  hoisting  engines  for  the  dis¬ 
charge  of  ballast,  hospitals  some  distance  removed  for  the 
care  of  the  sick,  the  New  Orleans  quarantine  station  is 
equipped  to  satisfy  every  demand  of  science,  of  commerce, 
►  and  of  humanity,  and  the  practical  experience  of  three  suc¬ 

cessive  seasons  demonstrates  its  sufficiency  to  effectually 
deal  with  that  poison  which  has  eluded  the  grasp  of  the 
pathologist  and  the  vision  of  the  microscopist,  the  yellow 
fever  germ. 

The  treatment  absolutely  necessary  for  actually  infected 
vessels  must  approach  very  closely  to  that  in  vogue  in  Lou¬ 
isiana,  or  public  apprehension  of  the  danger  from  vessels 
otherwise  infected  cannot  be  allayed  until  long  years  of  suc¬ 
cessful  work  under  those  different  methods  practically  de¬ 
monstrate  their  sufficiency. 


APPENDIX  III. 


QUARANTINE  REGULATIONS. 

BY  COL.  J.  C.  CLARK,  VICE-PRESIDENT  MOBILE  &  OHIO  RAILROAD. 


To  the  Chairman  oj  Quarantine  Convention ,  Montgomery ,  Ala. 

Sir  : — My  experience  in  operating  railroads,  under  quar¬ 
antine  regulations,  leads  me  to  suggest  : 

1.  There  should  be  uniform  rules  adopted  for  the  man¬ 
agement  of  quarantines,  as  far  as  practical,  which  regula¬ 
tions  should  name  what  articles  of  merchandise,  Ac.,  &c.,  if 
any,  should  be  permitted  to  be  transported  by  railroads,  to, 
from  or  through  infected  points,  during  the  prevalence  of 
yellow  fever  or  other  infectious  or  contagious  diseases,  to 
enable  railroads  to  co-operate  with  boards  of  health,  in  re¬ 
fusing  to  receive  for  transportation,  such  articles  as  are 
prohibited. 

2.  A  well  digested  quarantine  formula,  making  and  pro¬ 
mulgating  the  necessary  rules  and  regulations  for  enforcing 
the  same,  should  be  prepared,  ready  to  be  put  in  force 
when  necessary  to  do  so,  at  all  points  where  it  is  necessary 
to  put  quarantine  in  force.  These  rules  should  be  published 
for  public  information,  to  enable  all  persons  to  comply  with 
the  same,  and  displayed  by  placard  in  every  depot, 

3.  At  quarantine  stations,  accommodations  should  be 
provided  for  caring  for  such  persons,  if  any,  that  may  be 
detained,  or  are  not  permitted  to  pass  through  such  sta¬ 
tions,  while  in  transit  until  they  can  be  disposed  of. 

4.  Only  first-class,  reputable  physicians,  who  have  had 
experience  with  contagious  and  infectious  diseases,  should 
be  made  inspectors  at  quarantine  stations  upon  railroad 


69 


trains,  travelling  to  and  from  designated  points,  whose  duty 
shall  be  to  inspect  and  examine  the  condition  of  passengers, 
baggage  and  express  matter.  Such  inspectors  should  have 
the  power  to  admininister  oaths,  and  to  remove  from  the 
trains,  or  detain  such  passengers,  baggage  or  express  mat¬ 
ter,  <fcc.,  as  may  be  found  necessary  to  prevent  the  introdnc- 
tion  or  spread  of  infectious  or  contagious  diseases  of  any 
kind. 

5.  State  boards  of  health  should  be  the  powers  author¬ 
ized  to  put  quarantine  in  force.  They  should  determine 
when,  where  and  for  what  length  of  time  quarantines  should 
be  maintained;  provide  the  means  necessary  for  enforcing 
the  same,  and  promulgate  rules  and  regulations  for  con¬ 
ducting  quarantines. 

Presidents  and  secretaries  of  state  boards  should  be  re¬ 
quired  to  visit  and  inspect  all  quarantine  stations,  as  often 
as  practicable,  during  the  existence  of  such  quarantines; 
and  to  make  public,  over  their  signatures  and  official  posi¬ 
tions,  the  general  condition  of  the  public  health  at  the 
points  where  quarantines  are  established,  and  the  localities 
affected  by  such  quarantines.  Local  health  officers,  muni¬ 
cipal  or  county  authorities,  may  establish  quarantine  regu¬ 
lations,  conferring  with  the  state  board,  if  deemed  necessa¬ 
ry,  for  co-operation.  The  regulations  for  governing  local 
quarantines  should  not  be  in  conflict  with  the  rules  and  reg¬ 
ulations  adopted  by  the  state  boards  of  health  for  enforcing 
quarantine  regulations. 

6.  The  national  government  should  take  charge  of  and 
maintain  a  rigid  maritime  quarantine,  and  locate  snch 
quarantnne  stations  at  such  points  on  the  sea-coast 
and  on  navigable  rivers,  at  proper  points,  so  as  to 
prevent  the  introduction  of  yellow  fever  or  any  oth¬ 
er  contagious  or  infectious  disease  into  any  state  or 
territory  of  the  United  States,  leaving  to  the  state  authori¬ 
ties,  the  power  to  deal  with  these  matters  in  the  states, 
outside  of  maritime  quarantine.  It  should  be  the  duty  of 
the  general  government  to  provide  and  conduct  such  mar- 


70 


itime  quarantines,  so  as  to  prevent  the  introduction  of  yel¬ 
low  fever,  or  any  other  infectious  or  contagious  diseases 
from  being  communicated  to  the  inhabitants  or  people 
of  any  state  or  territory  of  the  United  States. 

If  this  were  done,  and  earnest  co-operation  secured, 
there  wonld  be  no  conflict  or  friction  detrimental  to  the 
general  public  health,  between  state  and  United  States  au¬ 
thorities;  but  a  hearty,  earnest  effort  to  secure  the  pur¬ 
pose  intended— the  preservation  of  general  public  health. 

7.  When  any  suspicious  case  occurs,  the  nature  of 
which  has  not  or  cannot  be  determined  at  its  then  present 
tage,  or  doubts  arise  as  to  the  nature  of  the  case,  wise 
precaution  demands  that  such  case  be  immediately  isolated 
from  contact  with  all  other  persons  until  medical  science 
has  diagnosed  the  case,  and  is  able  to  determine  the  nature 
of  it,  beyond  doubt.  When  conclusions  are  reached,  they 
should  be  made  public.  Such  a  course  would  allay  the 
fears  of  the  people  generally. 

8.  Experience  has  proven  that  by  proper  precautions 
and  constant  vigilance  on  the  part  of  well  organized  Boards 
of  Health,  yellow  fever  and  other  contagious  and  infectious 
diseases,  can  be  kept  out  of  the  country,  without  resorting 
to  the  doctrine  of  absolute  non-intercourse,  or  paralyzing 
commerce  and  industrial  pursuits,  or  interdicting  travel 
within  or  beyond  the  limits  of  state  lines. 

9.  The  legislatures  of  the  different  States  should  appro¬ 
priate  such  sums  of  money,  as  a  fund  for  protecting  the 
public  health  in  the  states,  as  would  be  sufficient  to  meet 
all  necessary  expense  incurred  for  this  purpose,  under  a 
well  digested  law,  throwing  proper  safe-guards  around  such 
appropriations,  so  as  to  insure  economy  and  responsibility. 
In  dealing  with  the  subject  of  the  general  public  health,  this 
is  a  matter  that  admits  of  no  pinching  policy,  and  the 
appropriations  should  be  large  enough  to  fully  provide  the 
necessary  safe-guards,  and  thus  meet  the  purpose  intended, 
the  preservation  of  the  general  public  health.  With 
proper  officers  conducting  this  matter,  no  more  money 
would  be  expended  than  is  absolutely  necessary, 


APPENDIX  IV. 


THE  EPIDEMIC  OF  YELLOW  FEVER  AT  GAINES¬ 
VILLE,  FLORIDA,  AND  DEDUCTIONS  THERE¬ 
FROM  ;  BY  MR.  JOSEPH  VOYLE,  C.  E. 


Before  we  can  intelligently  devise  any  method  of  quaran¬ 
tine,  it  is  necessary  that  we  understand  something  of  the 
nature  and  habits  of  that  which  is  to  be  quarantined  against, 
so  as  to  bring  into  accord,  as  near  as  possible,  the  greatest 
degree  of  public  safety,  and  the  least  degree  of  public  em¬ 
barrassment. 

When  first  entering  upon  the  work  of  writing  a  history  of 
the  epidemic  of  yellow  fever  at  Gainesville,  Florida,  it  was 
intended  to  give  in  detail  every  incident  that  came  to  my 
notice.  This  being  altogether  too  voluminous  for  reading 
here,  and  having  much  that,  whilst  of  general  interest,  is 
not  directly  related  to  the  subject  before  us,  I  have  selected 
such  portions  as  appeared  to  me  to  be  worthy  of  consider¬ 
ation,  in  devising  methods  of  prevention,  or  avoidance  of 
yellow  fever.  • 

I  have  for  many  years  past  made  careful  study  of  every 
item  of  information  that  I  could  obtain  on  this  subject ; 
much  has  been  written  thereon,  but  so  entirely  has  this 
writing  been  confined  to  medical  men,  that  I  feel  as  if  I  was 
intruding,  by  offering  the  results  of  my  studies  on  this 
subject. 

But  the  doctor  in  his  noble  work  of  relief  at  the  bed¬ 
side  of  the  individual,  and  the  civil  engineer  in  his  work  of 
controlling  the  insanitary  conditions  of  the  community,  are 
both  in  a  position  to  study  the  course  of  an  epidemic, 


72 


although  from  different  standpoints.  If  it  be  made  a  matter 
of  mutual  interest,  they  can  together  do  far  more  than  either 
alone. 

Having  enjoyed  the  intimate  friendship  of  doctors 
eminent  in  their  profession,  and  experienced  in  yellow 
fever;  reading  whatever  I  could  find  written;  personally 
observing,  when  practicable,  I  have  necessarily  obtained 
some  practical  information  on  the  subject  before  us;  and 
this  1  have  tried  to  classify,  arrange  and,  as  it  were,  to 
crystalize  into  a  few  short  sentences  as  deductions  there¬ 
from;  and  as  they  are  from  a  far  wider  field  than  the  local¬ 
ity  of  my  short  history,  I  give  them  first;  then,  as  incidents 
are  related,  the  mind  will  readily  recall  and  compare. 

My  deductions  are — 

That  the  cause  is  specific  and  foreign  to  our  climate. 

It  is  practically,  to  the  general  public,  invisible  and  in¬ 
tangible. 

Its  transportation  and  multiplication  is  almost  altogether 
confined  to  human  beings,  and  to  fluid  or  moist  matter. 

It  is  strictly  non-contagious. 

It  is  infectious;  the  infection  is  confined  to  certain  limited 
conditions. 

It  is  not  always  epidemic. 

Epidemics  occur  only  under  certain  conditions. 

Epidemic  conditions  are  cosmic,  atmospheric,  terrestrial, 
and  require  the  presence  of  the  specific  cause. 

The  cosmic  conditions  are  periodically  recurrent,  and 
always  beyond  human  control,  but  they  are  partially  calcu¬ 
lable. 

The  atmospheric  conditions  result  from  the  cosmic  and 
terrestrial,  either  or  both;  the  cosmic  may  be  absent,  the 
terrestrial  is  always  necessarily  present. 

The  cosmic  intensifies  and  extends. 

Cosmic  conditions  are  general,  over  a  large  area. 

All  necessary  conditions  except  the  specific  cause,  may 
exist;  the  conditions  cannot,  without  the  specific  cause,  pro¬ 
duce  yellow  fever. 


73 


Atmospheric  and  terrestrial  conditions  are  confined  to 
limited  areas,  and  are  intimately  associated  with  each  other. 

Meteorologic,  as  a  part  of  atmospheric  conditions,  cause 
variation  in  terrestrial  conditions. 

Terrestrial  conditions  are  sometimes  very  small  in  area; 
’  recognizable  and  hence  avoidable. 

From  observation,  I  give  this  hypothesis  concerning  the 
specific  cause: 

That  it  is  a  distinct  entity. 

That  it  has  three  periods  in  its  life  history. 

That  these  are:  the  destructive,  the  transformative,  and 
the  infective. 

That  it  is  transferable  in  either  form,  but,  under  dissimi¬ 
lar  conditions. 

That  when  finding  a  lodgment  in  the  human  body,  it  in¬ 
cubates,  and  takes  the  destructive  form  ;  and  may  thus  be 
carried  from  place  to  place. 

That  it  is  ejected  from  the  body  when  its  destructive  life 
is  complete,  and  that  when  it  leaves  the  body  it  is  neither 
contagious  or  infectious. 

That  if,  when  ejected,  it  finds  suitable  conditions,  it  trans¬ 
forms  to  the  second  stage. 

That  in  the  second  stage  it  is  germinative  and  multiplying, 
producing  the  third  stage;  in  which  it  is  aerial,  or  aeriform, 
and  infective. 

That  finding  suitable  conditions,  the  second  form  may 
permanently  remain  and  produce  the  infectious  form. 

That  the  conditions  for  transformation  are  wet  or  moist 
dead  vegetable  matter,  and  a  suitable  temperature. 

-<  That  the  infectious  form  will  travel  to  a  considerable  dis¬ 

tance  in  a  moist  atmosphere  at  a  suitable  temperature. 

That  the  specific  cause  in  all  forms  is  rendered  perma¬ 
nently  inactive  by  low  temperature  and  absence  of  moisture. 

That  careful  cleanliness  without  destruction  of  foecal 
matter,  is  no  protection  against  yellow  fever. 

I  am  aware  that,  unsupported  by  well  established  facts, 
these  sentences  have  little  or  no  value  for  guidance  in  the 


74 


field  of  action.  I  come  from  the  field  of  action,  where  all 
other  occupations  being  suspended,  there  was  opportunity 
for  observation,  and,  with  a  desire  to  search  out  the  truth 
for  the  simple  sake  of  the  truth,  and  wanting  nothing  but 
the  truth,  as  far  as  I  could  understand  it,  I  collected  and 
classified  facts  as  I  found  them,  and  these  are  the  deduc¬ 
tions  therefrom. 

As  to  how  far  your  judgment  will  approve  my  deductions, 
let  my  sketch  of  the  life  history  of  the  epidemic  at  Gaines¬ 
ville,  Florida,  occupy  your  attention,  and  then  judge  for 
yourselves. 

•s 

As  I  have  cut  this  history  down,  to  save  time,  if  any  part 
be  too  sketchy  on  important  points,  I  shall  be  pleased  to 
give  further  details  thereon: 

First,  as  to  cosmic  conditions — 

Quite  recently  there  have  appeared  statements  that  there 
was  evidence  of  periodicity  in  widely  extended  epidemics, 
and  that  there  was  probably  an  influence  outside  of  the 
ordinary  conditions  for  health;  and  beyond  the  reach  of 
quarantine.  It  has  been  called  a  pandemic  wave.  Statistics 
of  epidemics  running  back  more  than  a  hundred  years, 
when  graphically  tabulated,  show  periodic  wave  crests, 
with  ripples  or  smaller  waves  between,  and  these  wave 
crests  appear  at  remarkably  regular  distances,  having  an 
average  of  eleven  and  a  half  years.  From  the  statistics  it 
was  shown  that  the  probable  return  of  the  wave  to  the 
United  States  would  be  in  1887,  entering  at  the  southern¬ 
most  point  of  the  Atlantic  States  and  moving  northwards. 
That  the  period  would  probably  be  four  years;  and,  seeing 
that  it  did  come  to  Key  West  in  1887,  and  more  northwards 
to  Tampa,  and  in  1888  further  northwards  to  Jacksonville 
and  other  places,  I  expect  to  see  it  this  year,  1889,  in  the 
latitude  of  Savannah  and  Charleston. 

This  period  of  eleven  and  a  half  years  is  the  period  of 
maximum  and  minimum  sun  spots,  also  of  greatest  heat  and 
cold,  and  other  phenomena. 

Permit  me  to  call  your  attention  to  other  diseases  in 


75 


epidemic  form,  co-existent  with  yellow  fever,  and  also  the 
unusual  epidemic  of  accidents. 

Call  it  what  you  will — there  exists  a  something,  from 
which  nothing  can  save;  precautions  may  mitigate,  they 
cannot  obviate. 

In  positions  where  yellow  fever  is  always  present,  its 
complete  history  is  never  known,  because  it  never  dies.  In 
centers  of  trade,  where  it  is  usually  widely  spread  before 
being  publicly  known  and  recognized,  its  history  is  incom¬ 
plete,  and  confused  with  other  forms  of  disease. 

Instances  of  complete  isolation  and  a  complete  history 
are  rare.  The  epidemic  at  Gainesville,  Florida,  offers 
nearly  a  complete  case. 

The  entire  community  were  on  guard  in  some  way  ;  every 
one  was  aware  of  the  existence  of  the  fever  in  the  State; 
and  also  of  the  importance  of  keeping  Gainesville  free,  as  it 
was  the  only  outlet  giving  to  travellers  from  southern  coun¬ 
ties  a  route  distant  from  known  infection. 

An  unusually  long  drought  prevailed  during  the  early 
summer.  The  rainy  season  did  not  set  in  until  August, 
then  came,  almost  daily,  a  deluge.  The  atmosphere  was 
highly  charged  with  moisture,  and  fungi  grew  everywhere. 
Rooms  closed  for  a  day  or  two  took  on  a  bad  odor.  Bed¬ 
ding  smelt  mouldy  even  in  well  aired  rooms.  Clean  beds 
were  really  disagreeable  from  the  mouldy  smell. 

Just  here  let  me  digress  a  moment  to  state  that  five  cells 
containing  a  saturated  solution  of  bichloride  of  mercury, 
used  to  amalgamate  battery  zincs,  was  completely  covered 
with  a  film.  An  examination  of  this  film  under  the  micro¬ 
scope  showed  a  cell  formation.  I  intended  watching  the 
growth  of  this  unexpected  phenomena,  but  public  measures 
prevented.  Fungus  and  lichen  thrived,  but  there  was  no 
sickness;  the  health  of  the  community  was  unusually  good; 
the  doctors  had  nothing  but  old  or  chronic  cases;  only 
three  were  in  practice,  where  at  other  times  there  had  been 
eight. 

There  was  widespread  complaint  of  slight  nausea,  pain  in 


76 


the  forehead  and  in  the  back  of  the  neck;  rarely  enough  to 
be  severe  or  disabling,  but  distinct.  In  every  case  after  re¬ 
covery  from  the  fever  these  symptoms  left. 

There  was  another  marked  symptom;  mental  trouble  that 
I  w7ish  to  speak  of  as  possibly  referable  to  the  pandemic 
wave;  a  sudden  awakening,  without  being  conscious  of  hav¬ 
ing  slept,  or  a  consciousness  of  a  momentary  lapse  of  mental 
action — it  is  indescribable — but  at  this  time  I  noticed 
railroad  and  other  accidents  occurring  as  if  they  too  were 
epidemic. 

In  the  testimony  of  the  men,  one  stated  that  he  saw  the 
signals,  but  did  not  realize  their  importance  until  too  late; 
why,  he  did  not  know.  Others  stated  that  they  could  not 
tell  why  they  did  not  do  as  usually  they  had  done  for  years 
before. 

Is  there  in  these  cases  a  mental  lapse;  a  momentary  sus¬ 
pension  of  brain  action?  It  was  certainly  one  of  the  symp¬ 
toms  of  yellow  fever;  a  momentary  failure  to  realize  facts 
presented,  followed  by  quick  apparently  normal  action  of 
thought,  in  total  ignorance  of  previous  lapse. 

Sanitary  measures  were  pushed  to  an  extreme,  in  some 
directions ;  some  matters  were  ignored  ;  badly  drained  de¬ 
pressions  and  choked  ditches  retained  the  water  that  filled 
them  until  it  was  absorbed  or  evaporated.  The  city  is  situ¬ 
ated  on  higli  ground,  with  good  natural  drainage. 

At  the  northern  boundary  a  stream  rises,  passes  under 
the  S.  F.  &  W.  R.  R.,  runs  east,  then  south,  when  due  east 
of  the  public  square  it  is  about  400  yards  distant,  and  is 
thirty  feet  below  the  square.  It  passes  under  the  F.  R.  & 
N.  R.  R.,  then  under  the  Fla.  Southern  R.  R ,  and  when  due 
south  of  the  transfer  depot  it  is  seventy  feet  below  its 
source.  Another  stream  rises  in  the  northwest  part  of  the 
city  and  runs  west,  with  a  fall  of  thirty  feet  in  half  a  mile. 
Still  another  stream  rises  in  the  western  part  and  flows 
south,  with  abundant  fall.  Gainesville  occupies  the  highest 
land  between  the  gulf  and  Atlantic  ocean,  lying  north  of  the 
peninsular  notch,  its  elevation  is  about  two  hundred  feet 


77 


above  sea  level.  Into  the  streams  above  mentioned,  ditches 
conduct  the  service  water.  There  is  no  complete  system  of 
drainage;  no  sewerage. 

When  the  guard’s  sickness  caused  alarm,  plans  were  made 
„  to  leave  the  city  if  it  proved  to  be  yellow  fever.  It  was  so 

announced  at  the  churches  on  Sunday  evening  September 
16th,  and  all  night  long  hurrying  crowds  filled  the  country 
roads,  and  by  morning  few  remained.  I  was  one  of  the 
few.  On  October  1st  I  wrote  and  published  the  following 
for  information  of  refugees  and  others  interested  : 

Gainesville’s  fever — an  effort  to  locate  the  cause  of  it. 

The  death  of  Maj.  N.  R.  Graelle,  after  three  days  of  yellow  fever,  has 
caused  a  stampede  among  the  few  remaining  citizens  of  this  place,  cast 
a  deeper  gloom  around  us,  and  shaken  the  faith  of  those  who  relied  im¬ 
plicitly  on  the  hon-infection  high  pine  land  theory. 

Theories  appear  to  be  all  sadly  at  fault  in  this  yellow  fever  matter. 
Doctors  disagree  and  experts  are  at  variance. 

After  all  the  experiences  of  past  epidemics,  it  is  reasonable  to  expect 
that  medical  men  should  readily  recognize  the  fever  in  its  incipiency, 
take  promptly  a  definite  line  of  action  with  a  high  average  of  favorable 
results,  and  so  inspire  confidence.  But  since  this  is  not  so,  there  must 
be  a  grave  fault  somewhere.  Is  the  fault  with  the  doctors?  The  doc¬ 
tor’s  proper  realm  is  the  treatment  of  disease  when  it  appears,  not  the 
prevention  of  its  appearance.  From  variety  of  surroundings  cases  may 
be  complicated  with  other  forms  of  fever,  thus  varying  the  symptoms, 
and  so  the  indications  in  the  experience  of  a  doctor  in  one  locality  may 
differ  essentially  from  that  of  another  not  similarly  located,  and  thus 
may  arise  honest  difference  of  opinion. 

There  is  needed  careful  investigation,  an  assemblage  of  facts,  well 
authenticated,  carefully  classified  and  compared  regardless  of  any  the- 
*  ory  or  any  one’s  reputation.  Such  investigation  should  be  made  by 

residents  of  some  years  within  the  area  of  probable  epidemic  action. 
Experts,  of  however  high  repute  elsewhere,  are  sadly  misled  by  mis¬ 
taken  ideas  in  unfamiliar  surroundings,  and  oftener  avoid  than  invite 
necessary  information  from  those  best  able  to  give  it  in  the  form  in 
which  it  will  be  most  useful. 

A  large  number  of  plain,  simple  statements  of  the  first  symptoms,  and 
the  progress  of  the  disease,  obtained  from  intelligent  persons  who  have 
passed  through  the  ordeal  of  yellow  fever,  might  be  collected,  classified 
for  similarity  and  variation,  and  deductions  therefrom  be  put  in  useful 
form  for  public  distribution.  A  similar  work  by  doctors  is  evidently  ad- 


78 


visable.  Unfamiliarity  with  symptoms  and  widely  varying  methods  of 
treatment  form  the  elements  of  the  wild  terror  inspired  by  the  possi¬ 
bility  of  being  a  victim  to  yellow  fever.  Thoroughly  isolated  cases, 
either  as  communities,  families,  or  individuals,  should  be  sought  out  as 
being  best  calculated  to  give  a  definite,  useful  series  of  facts. 

The  case  of  Gainesville  is,  to  some  extent,  thus  isolated.  A  com¬ 
pany  of  men  in  ordinary  health  are  absent  five  days,  their  whereabouts 
during  that  time  is  strictly  well  known.  They  return  nearly  all  sick. 
All  apparently  recover  except  six  ;  these  develop  yellow  fever.  They, 
with  the  friends  or  relatives  who  happened  to  be  with  them,  are  isola¬ 
ted.  The  fever  takes  its  course.  None  of  the  attendants,  not  even  in 
the  case  of  fatal  termination,  take  the  disease.  In  one  case  the  out¬ 
break  is  delayed  and  terminates  in  death.  Again  the  attendants 
escape. 

Here  we  have  one  prominent  fact,  verified  by  seven  isolated  and  dis¬ 
tinct  instances,  in  which  yellow  fever  is  brought  from  afar  and  intro¬ 
duced  into  the  midst  of  a  thickly  inhabited  region,  passes  through  all 
its  stages  there  without  communicating  itself  to  those  in  immediate, 
continuous  and  prolonged  exposure  to  its  influence. 

Seven  such  clearly  defined  cases  may  rarely  be  found,  and  they  form 
a  nucleus  around  which  to  assemble  similar  ones  when  found  ;  and  from 
all  to  try  to  ascertain  and  understand  the  conditions  of  this  immunity 
for  future  guidance. 

The  question  naturally  arises  here  :  Did  these  cases  contain  the  ele¬ 
ments  of  contagion?  and  further,  what  are  the  conditions  necessary  to 
immunity  and  to  contagion? 

Here,  sad  to  relate,  we  are  not  without  positive  information. 

When  a  wreek  or  more  had  passed  the  board  of  health  deemed  it  ad¬ 
visable  that  the  houses  of  refugees,  which  had  been  closed,  should  be 
opened  and  fumigated. 

Maj.  N.  R.  Gruelie  volunteered  to  perform  this  work.  He  told  the 
writer  that  he  found  in  several  houses  a  foetid  odor  from  decaying  food 
and  other  matter  left  in  the  stampede.  This  he  and  his  assistants  re¬ 
moved  before  fumigation. 

In  this  work  he  hurried  from  place  to  place  and  over-exerted  himself, 
as  shown  by  his  perspiring  condition  and  fatigued  appearance  on  a  very 
hot  day.  Being  asked  why  he  did  not  keep  out  of  town  he  replied,  “I 
am  not  afraid  of  the  yellow  fever  spreading  in  this  pure  atmosphere.” 
Turning  to  your  correspondent,  he  said,  “I  do  not  really  know  howT  far 
I  have  been  exposed,  and  I  don’t  want  to  go  beyond  prompt  help,” 

Maj.  Gruelie  and  Dr.  Fitch  Miller  were  intimately  associated  in  busi¬ 
ness.  The  major’s  office  was  in  the  same  building  where  Mr.  Ammon’s 
room  was,  using  the  same  entrance.  Dr.  Miller’s  death  from  the  fever 
was  a  sad  blow  to  him,  and  deepened  the  fear  of  his  possible  infection. 
He  was  stricken  down  with  the  disease  and  on  the  third  day  he  died. 


79 


We  can  trace  Maj.  Gruelle’s  whereabouts  every  (lav  during  the  period 
of  the  fever  brought  by  the  guards,  and  know  that  he  had  not  been  ab¬ 
sent  from  here  during  that  time,  nor  for  some  time  previous,  nor  had 
any  member  of  his  large  family  been  away  recently. 

The  evidence  appears  to  be  conclusive  that  he  was  infected  by  the 
fever  brought  her^  by  the  guards,  consequently,  the  fever  was  communi¬ 
cable  in  its  most  fatal  form.  Here  we  are  met  by  one  of  those  diffiulties 
which  beset  the  path  of  investigation.  Those  in  the  constant  presence 
of  the  disease  escape  without  any  trace  of  its  effect  on  themselves; 
another,  after  questionable  exposure,  is  smitten  to  death.  There  must 
be  a  reason  for  this.  Yellow  fever  must  act  in  accordance  with  nature’s 
fixed  laws,  and  these  laws  are  not,  presumably,  past  finding  out. 

We  have  here  from  the  same  introduction,  cases  of  complete  non¬ 
infection,  and  also  fatal  infection.  Can  we  separate  them?  Like  causes 
under  like  conditions  invariably  produce  like  results.  Here  we  have  a 
given  cause,  but  opposite  results. 

The  results  being  different  whilst  the  cause  remains  the  same,  the 
conditions  must  be  different.  If  we  can  find  any  marked  difference  of 
conditions  in  these  cases,  it  may  form  a  guide  to  further  investigation 
elsewhere,  and  the  recurrence  of  similar  conditions  where  the  fever  has 
become  epidemic,  may  mark  a  step  in  progress  toward  the  recognition, 
avoidance  or  removal  of  that  one  condition  conducive  to  the  spread  of 
this  hitherto  untamable  horror. 

As  soon  as  the  cases  were  decided  to  be  yellow  fever,  all  persons  in 
the  houses  infected  were  confined  therein,  none  allowed  to  go  in  or  out, 
and  nothing  to  pass  out ;  complete  isolation  was  strictly  enforced  by 
armed  guards. 

In  these  houses  conditions  for  infection  presumably  did  not  exist. 

What  possible  difference  of  condition  could  Maj.  Gruelle  have  en¬ 
countered?  His  residence  was  nearly  one  mile  east  of  the  court  house, 
just  outside  the  city  limits,  and  less  than  200  yards  beyond  the  house  of 
Mrs.  Evans,  where  her  son,  Lieut.  Evans,  died  of  the  fever.  Between 
these  two  houses  there  was  a  low  place,  where  water  stood  after  heavy 
rains. 

The  major  mentioned  this  wet  place  to  your  correspondent  and  said 
that  it  had  puzzled  him  as  to  which  was  best  to  do,  to  dig  a  ditch  to 
drain  the  water,  and  so  expose  fresh  earth  to  the  atmosphere,  or  let  the 
water  stand  and  evaporate  and  stagnate;  that  he  had,  however,  decided 
to  dig  the  ditch,  and  it  was  being  done  then. 

Now  for  difference  of  conditions.  We  have  several  persons  isolated 
with  cases  of  yellow  fever,  but  they  are  neither  over-worked  physically, 
exposed  to  foul  atmosphere  of  closed  rooms,  to  night  air,  neighborhood 
of  stagnant  water  or  emanations  from  freshly  moved  wet  earth  in  the 
immediate  vicinity  of  a  virulent  case  of  yellow  fever. 

But  we  find  that  Maj.  Gruelle  encountered  all  of  these ;  the  exposure 


80 


to  night  air  was  only  the  chilly  time  of  the  late  evening,  but  at  that 
time  he  passed  into  and  through  the  atmosphere  over  the  wet  spot. 

Now,  are  all  of  these  conditions,  or  only  one,  conducive  to  the  spread 
of  yellow  fever?  Mr.  Gruelle’s  assistants  were  as  much  exposed  to  the 
air  in  the  closed  rooms  as  he  was  ;  none  of  them  are  sick.  Others  were 
verj  tired  from  over-exertion,  got  home  as  late  as  he  did,  but  are  still 
well.  If  the  wet  atmosphere  is  the  condition  others  should  then  be  also 
infected  by  his  presence  and  favorable  conditions.  They  are.  Two 
members  of  his  family  have  the  fever. 

The  inference  is  thus  warranted  that  one  of  the  conditions  under 
which  yellow  fever  can  spread  is  produced  by  the  evaporation  of  water 
from  freshly  stirred  wet  earth,  or  from  dead  vegetable  matter. 

This  is  only  an  inference,  but  it  directs  inquiry  to  other  places  where 
the  disease  has  spread,  and  suggests  the  question  :  Is  there  always  an 
area  of  fresh  earth,  or  dead  vegetable  matter,  wet  enough  for  long  con¬ 
tinued  evaporation  ?  and,  does  the  fever  exist  there  when  these  spots 
are  dry? 

Let  us  inquire  of  Plant  City.  We  are  informed  that  this  place  is  of 
recent  origin  and  rapid  growth,  situated  in  a  hitherto  healthy  pine  re¬ 
gion.  There  are  large  areas  of  pine  sawdust  in  shallow  wet  places ;  but 
pine  sawdust,  we  are  told,  is  healthy  to  have  around. 

Let  us  look  at  Macclenny.  It  is  the  same  condition.  The  sawdust 
there  has  been  spread  over  the  streets,  fresh  land  has  been  cleared,  pine 
stumps,  limbs  and  roots  are  passing  through  ferment  to  decay  in  the 
immediate  vicinity.  What  of  Jacksonville?  We  find  no  large  areas  of 
sawdust  there.  There  are  handsome  streets,  clean  as  can  be  in  any 
business  city,  and  it  is  situated  partially  on  high  sand  ridges,  with  the 
broad  St.  John’s  river  on  one  side  and  arms  of  the  river  on  the  other, 
with  natural  drainage  in  both  directions.  What  can  cause  the  epidemic 
there?  We  must  hunt  for  something  different,  possibly  akin  to  con¬ 
ditions  noted  elsewhere. 

At  the  wharves  and  railroads  there  is  a  large  area  of  dead  vegetable 
matter  exposed,  but  it  is  dry  ;  in  the  marshes  there  is  a  large  wet  area, 
but  it  is  covered  with  living  vegetable  matter.  The  marshes  have  been 
built  out  upon,  the  river  margin  has  been  built  out  upon.  Has  any  new 
work  been  done?  No.  What  is  the  material  of  the  filling?  Princi¬ 
pally  slabs,  refuse  from  saw  mills,  sometimes  covered  by  a  layer  of 
earth,  and  sometimes  by  a  cover  of  plank. 

Let  us  examine  this  pile  of  the  road  blocks  used  in  the  streets.  Cy¬ 
press  trees  about  the  size  of  large  telegraph  poles  are  cut  into  blocks 
about  five  inches  long.  These  are  placed  end  up  on  boards,  the  crevices 
filled  with  small  pieces  and  sand.  It  is  claimed  that,  being  made  of 
cypress,  there  would  be  no  rotting,  and  consequently  no  danger  of  dis¬ 
ease  from  these  blocks. 

There  was  no  epidemic  in  Jacksonville  until  August, 


81 


During  the  early  summer  there  was  an  unusually  extended  drought. 
The  rainy  season  set  in  in  August. 

The  conditions  we  find  in  Jacksonville  are  that  these  road  blocks  fur¬ 
nish  acres  upon  acres  of  dead  vegetable  matter.  During  the  early  part 
of  the  hot  season  the  blocks  were  dry.  When  the  rainy  season  sets  ip 
they  present  an  immense  surface  for  evaporation,  each  block  being  a 
miniature  sponge.  As  long  as  this  surface  was  dry  there  was  no  epi¬ 
demic.  As  soon  as  it  became  saturated  with  water  the  conditions  for 
continuous  evaporation  over  a  large  area  were  complete,  and  coincident 
therewith  the  epidemic  began.  If  then,  on  the  return  of  dry  weather 
the  epidemic  abates,  it  will  further  corroborate  the  evidence  that  evap¬ 
oration  of  water  from  a  surface  of  dead  vegetable  matter,  under  a  suita¬ 
ble  temperature,  is  intimately  associated  with  conditions  favorable  to 
yellow  fever  in  epidemic  form. 

The  evidence,  however,  is  not  conclusive.  It  is  circumstantial,  show¬ 
ing  coincidences  that  are  very  suspicious,  and  apparently  presents  a 
clew  leading  to  the  discovery  of  the  truth.  Such  investigation,  con¬ 
tinued,  will  surely  lead  to  a  better  knowledge  of  conditions.  Then 
their  avoidance  will  follow,  and  a  modification  of  the  ravages  of  the  dis¬ 
ease  must  result,  and  all  the  attendant  horrors  of  stampedes,  quaran¬ 
tines,  etc.,  become  tales  of  the  past. 

Let  us  return  to  Major  Gruelle’s  family.  The  family  was 
moved  to  another  house,  about  three  hundred  yards  distant  from 
their  own.  This  house  was  situated  on  a  lot  that  was  formerly 
a  pond;  a  large  ditch  ran  along  the  valley  near  the  house. 
After  a  few  days  the  members  of  the  family  not  sick  were 
taken  to  the  quarantine  hospital ;  leaving  two  sick  at  the  house ; 
one  of  these  died.  None  of  the  attendants  at  this  house  at  this 
time  were  sick.  This  house  was  used  as  a  pest  house,  and  other 
cases  were  moved  into  it ;  there  were  two  deaths  there ;  one 
attendant  was  taken  sick  there.  Later  after  some  warm  misty 
weather  there  were  at  the  two  heads  of  the  ditch,  four  cases, 
one  fatal.  Still  later  after  a  few  days  of  foggy  weather,  there 
was  a  case  in  a  house  on  a  sandy  ridge,  about  two  hundred 
yards  from  this  pest  house,  a  large  family  of  children  remain¬ 
ed  in  the  house,  none  of  them  on  the  attendant  took  the  disease. 

Two  of  the  original  cases  of  guards  show  no  subsequent  cases 
traceable  to  them ;  both  were  in  thickly  populated  neighbor¬ 
hoods,  one  on  a  sandy  ridge,  and  no  precautions  taken  with  fe¬ 
cal  matter,  the  other  on  rich  soil,  but  all  fecal  matter  chemi- 
6 


82 


cally  treated.  Two  cases  were  in  one  house,  no  attendants  were 
infected,  the  last  case  of  the  guards  was  also  moved  here,  it 
was  fatal  ;  all  survivors  were  moved  to  the  quarantine  hospi¬ 
tal.  The  fecal  matter  of  these  three  cases  was  disposed  of  at 
the  closet  at  the  back  of  a  small  garden.  After  the  house  was 
vacated,  two  persons  visited  the  lane  close  to  the  closet,  they 
both  took  the  fever ;  at  their  homes  none  of  the  family  took  it 
from  them.  A  colored  man  slept  in  a  room  near  this  closet ; 
he  took  the  fever. 

The  other  two  original  cases  show  the  same  immunity  of 
attendants.  Near  the  house  occupied  by  one  of  these,  is  a 
ditch  leading  to  a  larger  ditch  ;  these  were  nuisances  ;  disin¬ 
fectants  had  been  freely  used  in  them.  After  a  period  of  wet 
and  foggy  weather,  the  fever  entered  a  family  living  near  the 
ditch,  and  father,  mother  and  daughter  died  in  quick  succes¬ 
sion.  The  mother  and  daughter  had  attended  the  father  ;  two 
sons  escaped.  In  another  house  right  on  the  ditch  a  man  and 
his  wife  had  the  fever,  the  husband  died,  the  wife  recovered. 

By  this  time  the  foci  were  so  numerous  that  the  whole 
city  was  considered  poisoned.  The  U.  S.  M.  H.  service  was 
in  charge  of  the  place. 

In  the  beginning  precautions  as  to  complete  isolation  and 
non-communication  were  observed,  and  enforced  by  arms,  and 
carried  to  the  extent  of  taking  all  relatives  away  from  the  suf¬ 
ferers  and  placing  hirelings  in  charge,  and  allowing  those  ta¬ 
ken  away  to  take  no  other  clothing  than  that  upon  them  ; 
and,  as  no  other  was  provided,  smuggling  was  carried  on  • 
clothing  direct  from  infected  houses  was  obtained  and  worn, 
and  no  evil  effects  followed. 

From  avoiding  the  street  where  a  yellow  flag  waved,  through 
every  gradation  of  crossing  to  the  other  side,  not  crossing  to 
barely  noticing ;  and  from  a  wild  terror  of  one  stricken  down, 
to  sitting  by  the  bedside,  are  .the  gradations  through'  which 
our  people  passed.  From  non-intercourse  to  no  restriction 
whatever.  All  of  these  changes  in  conduct  appeared  to  make 
no  change  in  the  epidemic ;  an  examination  of  the  chart  gives 
no  evidence  of  these  changes. 


83 


When  the  epidemic  was  at  its  worst  the  State  and  National 
election  came  on,  and  the  polls  were  opened  for  Gainesville  in 
a  house  where  it  was  afterwards  known  that  a  concealed  case 
of  yellow  fever  had  been. 

Here  were  the  usual  crowdings  of  elections,  persons  with 
distinct  symptoms  of  the  fever  on  them  were  seen  here,  and 
an  outbreak  was  expected  ;  but  it  did  not  come.  One  of  the 
family  occupying  the  house,  the  wife  of  the  man  who  was 
sick  there  before,  subsequently  had  the  fever  ;  but  no  case  was 
traceable  to  this  mixing  up  of  people  from  the  infected  and 
non-infected  places. 

A  census  showed  only  150  whites  and  — - colored  people 

within  the  city  limits.  Business  was  done  between  the  hours 
of  9  and  3,  and  on  sunshiny  days  many  persons  came  in  be¬ 
tween  these  hours ;  and,  no  case  was  reported  where  these 
hours,  in  fine  weather,  were  adhered  to  ;  but  several  cases  oc¬ 
curred  from  visits  made  in  wet  and  foggy  weather.  Much  of 
the  weather  during  the  latter  part  of  October  and  in  Novem¬ 
ber  was  wet ;  in  November  very  wet. 

Speaking  of  the  house  lots,  the  infection  began  in  the  clean¬ 
est  places  in  the  city,  in  the  ordinary  meaning  of  cleanliness. 
Shall  I  be  understood  if  I  say,  the  soil,  the  dirt  was  clean  ? 
Continued  rains  made  the  soil  wet ;  during  the  epidemic  it 
was  rarely  dry ;  and  often  flooded  to  saturation,  so  that  drain¬ 
age  was  slow,  but  the  temperature  remained  high.  Up  to  the 
middle  of  November  the  weather  was  warm,  never  below  75 
degrees  Farenheit,  often  85. 

On  the  20th  November  it  turned  cold,  there  followed  a  re¬ 
duction  of  cases  within  the  next  two  days  ;  on  the  23d  there 
was  no  case  reported  for  the  'first  time  since  October  25th. 
Two  were  reported  November  24th,  25th  none ;  we .  had  the 
first  ice  on  this  day  ;  during  the  next  night  the  temperature 
was  still  lower  and  by  morning  ice  formed  one-fourth  inch  in 
thickness.  On  this  day,  November  26th,  three  cases  were  re¬ 
ported,  27th  one  case,  28th  two,  and  this  ended  the  epidemic. 

The  chart  shows  a  periodic  grouping  in  the  beginning  of  the 
epidemic,  further  on  it  becomes  fuller  between  groups  and 


84 


probably  in  a  longer  continuance  there  would  have  been  such 
an  overlapping  of  periods  as  to  show  no  grouping  at  all.  These 
groups  appear  to  have  some  significance ;  especially  as  the 
epidemic  ceased  within  a  group  period,  after  the  first  frost. 
If  the  chart  groups  show  the  period  of  incubation,  then  seven 
days,  dating  from  exposure,  is  the  least  period  of  safety  for 
quarantine  of  persons. 

As  the  character  of  the  surroundings  of  residences  of  those 
attacked  with  the  fever,  appeared  to  have  a  decided  influence, 
not  only  on  the  spreading  of  the  disease,  but  in  intensifying  its 
effects,  I  have  classified  the  cases  of  the  whites  under  the 
heads,  Wet  surroundings  :  which  includes  proximity  of  drains 
or  ditches,  and  dry  surroundings. 

This  shows, 

Wet  surroundings  14  cases,  9  deaths,  5  recoveries. 

Dry  surroundings,  30  “  3  “  27  recoveries. 

Nearly  all  wet  surroundings  were  temporary,  the  result  of 
long  continued  rains. 

The  dry  surroundings  were  the  results  of  higher  positions, 
or  more  porous  soil. 

It  is  an  interesting  question,  whether  or  not  the  fever  would 
have  spread  beyond  the  original  cases  had  the  weather  been 
dry. 

The  introduction  of  skilled  nurses,  was  by  far  the  most  im¬ 
portant  of  all  the  measures  taken  for  relief  and  care  of  the 
sufferers.  The  nurses  are  held  in  grateful  remembrance  in 
Gainesville.  They  inspired  confidence,  gave  hope,  and  the 
much  needed  practical  instruction. 

The  physician  cannot  be  the  nurse,  and  skilled  nurses  can¬ 
not  be  improvised.  Kindness  to  the  sick,  it  was  found  might, 
when  unaccompanied  by  proper  knowledge,  be  as  fatal  as  neg¬ 
lect. 

Bedding  and  clothing  used  without  disinfecting  beyond  or¬ 
dinary  washing  and  airing,  gave  no  trace  of  infection  ;  even 
bed-fellows  were  not  infected  where  the  fever  was  brought 
home  by  one  of  them. 

I  can  trace  no  case  where  the  disease  was  carried  from  an 


85 


infected  spot  by  anything,  or  any  means  other  than  a  sick  per¬ 
son  who  was  him  or  herself  infected. 

In  the  light  of  the  information  displayed  by  the  epidemic 
of  yellow  fever  at  Gainesville,  Fla.,  quarantine  against  this 
particular  disease  should  be  directed  to  human  beings  and 
fluids,  wet,  or  moist  material  from  infected  regions,  and  that 
when  the  disease  is  introduced  to  a  community,  all  fecal  mat¬ 
ter  from  the  diseased  persons,  and  suspects,  should  be  chemi¬ 
cally  disorganized,  and  placed  in  a  special  receptacle ;  this  to 
be  removed  for  further  disposal ;  preferably  by  fire  for  extra 
precaution. 

Under  such  a  regime  business  becomes  enfranchised  within 
certain  definite  limits.  Traffic  is  continued  under  definite  reg¬ 
ulations.  Travellers  can  know  beforehand  definitely  the  period 
of  their  legal  detention,  and  make  provision  therefor.  And 
thus  the  curse  that  fell  upon  the  little  city  on  the  hills  of  Flor¬ 
ida  may  become  a  blessing  to  the  people  who  so  generously  ex¬ 
tended  their  kindness  to  her,  in  her  sad  hour  of  need. 


APPENDIX  V. 


RESOLUTIONS  OFFERED  BY  MR.  B.  R.  FOREMAN, 

OF  NEW  ORLEANS. 


Resolved ,  That  it  is  the  sense  of  this  convention,  that 
the  time  has  come  when  Federal  Resources  and  Federal 
power  should  be  organized  and  exercised  to  regulate  and 
control  Inter-state  as  well  as  foreign  quarantine,  and  to  pre¬ 
vent  the  introduction  and  extension  of  contagious  and  in¬ 
fectious  diseases  in  the  United  States,  and  to  this  end,  there 
should  be  passed  an  act  by  the  Congress  of  the  United 
States,  for  the  appointment  of  a  “chief  commissioner  of 
health  of  the  United  States,”  who  should  be  charged  with 
the  collection  and  distribution  of  information  relative  to 

•  m 

contagious  and  infectious  diseases,  and  have  the  direction 
of  the  sections  of  the  health  commission  when  on  active 
duty. 

There  should  also  be  a  health  commission,  to  be  divided 
into  six  sections  ;  each  section  to  be  especially  devoted  to 
directing  the  investigation  of  the  disease  with  which  it  is 
charged,  indicating  cause,  origin,  mode  of  extension  and 
measures  of  prevention  : 

1.  One  section  for  yellow  fever. 

2.  One  for  cholera. 

3.  One  for  typhoid  fever. 

4.  One  for  scarlet  fever. 

5.  One  for  small-pox. 

6.  One  for  diptheria. 

This  health  commission  should  adopt  rules  and  plans  for 
the  prevention  of  the  introduction  into  the  United  States  of 
contagious  and  infectious  diseases,  and  the  prevention  of 


87 


their  spread  from  one  state  into  another,  and  the  regulation 
of  inter-state  communication  during  a  threatened  epidemic. 

Whenever  an  epidemic  of  any  of  the  diseases  named  is 
threatened,  the  governor  of  any  state  may  call  upon  the 
chief  commissioner  of  health,  who  shall  then,  with  the  aid 
of  the  section  of  the  health  commissioner  devoted  to  that 
particular  disease,  enforce  and  carry  out  the  methods  and 
regulations  adopted  by  the  health  commission  for  that  dis¬ 
ease,  and  thus  concentrate  the  powers  and  resources  of  the 
Federal  Government,  in  aid  of  state  and  local  authority,  for 
the  prevention  of  the  spread  of  contagious  and  infectious 
diseases,  in  a  peaceably,  orderly  and  effective  manner. 


APPENDIX  VI. 


REMARKS  OF  DR.  W.  G.  AUSTIN,  OF  NEW  OR¬ 
LEANS. 


After  the  remarks  made  by  Dr.  Hyer,  of  Miss.,  in  regard 
to  the  National  Board  of  Health  work  in  1878,  Dr.  W.  G. 
Austin,  of  Louisiana,  asked  permission  of  the  Conference  to 
make  a  statement  in  regard  to  the  work  done  by  the  Nation¬ 
al  Board  of  Health,  in  aiding  the  Louisiana  State  Board  in 
stamping  out  the  fever  in  1879.  He  stated  that  the  Nation¬ 
al  Board  of  Health  was  not  organized  for  work  in  1878,  and 
not  until  late  in  1879.  When  the  fever  made  its  appearance 
in  the  fourth  district  in  New  Orleans  the  State  Board  had 
exhausted  all  its  means  in  the  . epidemic  of  the  previous 
year.  We  were  in  need  of  money  to  do  the  work  necessary 
to  stamp  out  the  disease.  We  applied  to  the  National 
Board  for  funds  to  aid  us  in  carrying  on  this  work  ;  they 
promised  us  aid  in  two  weeks.  We  could  not  wait. 

Through  the  assistance  of  General  Manager  J.  C.  Clarke, 
of  the  Illinois  Central  Railroad,  Dr.  Herrick,  the  Secretary 
and  myself,  Acting  President  of  the  Board,  borrowed  the 
money  from  the  Canal  Bank  to  do  the  work  until  the  Na¬ 
tional  Board  could  come  to  our  assistince,  which  they  did 
in  about  ten  days,  enabling  the  State  Board  of  Health,  with 
the  assistance  of  the  Auxiliary  Sanitary  Association  of  New 
Orleans,  to  stamp  out  the  disease  in  a  short  time,  thus  pre¬ 
venting  a  repetition  of  the  dreadful  epidemic  of  1878  ;  the 
National  Board  furnishing  us  money  to  pay  our  indebted¬ 
ness  to  the  Canal  Bank  and  all  other  expenses  incurred. 

On  visiting  the  Hood  residence  after  the  death  of  Gen. 
Hood,  his  wife  and  child,  with  Dr.  Bell,  of  New  York,  we 


t 


89 

found  the  balance  of  the  family  sick.  Upon  examination  we 
ascertained  there  was  under  the  house  an  immense  cess 
pool,  in  which  was  emptied  all  the  feculent  matter  coming 
from  the  water  closets  above.  This  vault  had  no  ventila¬ 
tion  whatever,  for  the  gases  to  escape,  thus  accounting  for 
the  walls  of  the  house  being  perfectly  saturated  with  the 
gasses  produced  from  human  feculent  matter.  The  vault 
proved  to  be  about  ten  feet  square,  lined  with  cement  and 
covered  with  a  large  stone  also  laid  in  cement.  With  great 
difficulty  we  removed  the  stone,  when' the  gas  coming  from 
this  vault  put  out  all  our  lights  and  drove  the  force  from 
under  the  house.  We  emptied  the  vault,  disinfecting  it 
thoroughly,  putting  in  large  quantities  of  carbolic  acid,  sul¬ 
phate  of  iron,  chloride  of  lime  and  quick  lime,  then  filled  it 
up  with  river  sand  and  had  all  the  pipes  changed  to  a  new 
vault  which  we  prepared  outside  of  the  building. 

At  the  suggestion  of  Dr.  A.  N.  Bell  we  moved  the  sick 
children  on  the  other  side  of  the  hall,  and  they  all  recover¬ 
ed  under  the  treatment  of  Dr.  Bemiss,  who  was  the  physi¬ 
cian  of  the  Hood  family  and  a  member  of  the  National 
Board. 

The  fever  of  1879  had  evidently  wintered  over  from  the 
previous  year,  for  the  reason  that  it  commenced  exactly 
where  it  had  left  off  in  1878.  The  odor  from  the  walls  of 
the  rooms  was  so  strong  that  Dr.  Bell  remarked  that  he 
would  not  live  in  the  house  if  it  were  made  a  present  to 
him. 

I  make  this  statement  for  the  reason  that  I  was  not  cor¬ 
rectly  reported  in  my  remarks  made  yesterday,  to  show 
that  the  work  by  the  National  Government,  in  aiding  State 
Boards  of  Health,  will  prove  a  success,  judging  from  the  aid 
given  the  Louisiana  Board  in  1879. 


APPENDIX  VII. 


HUNTING  YELLOW  FEYER  GERMS. 

BY  DR.  GEO.  M.  STERNBERG,  TJ.  S.  A. 


Gentlemen — It  would  have  been  far  more  satisfactory  to  you 
and  to  me  if  the  subject  of  my  address  this  evening  could  have 
been  announced  as  “the  yellow  fever  germ.”  I  need  hardly 
say  that  nothing  would  have  given  me  greater  pleasure  than, 
in  the  presence  of  the  experts  in  the  clinical  and  prophylactic 
management  of  yellow  fever  here  assembled,  to  exhibit  micro¬ 
scopic  preparations  and  pure  cultures  of  the  specific  infectious 
agent  which  I  have  been  so  long  in  search  of.  I  shall  show 
you  presently  upon  the  screen  photo-micographs  of  a  variety 
of  micro-organisms  which  I  have  encountered  in  the  course  of 
my  researches,  some  of  which  are  hitherto  undescribed  species, 
and  among  them  some  which  have  especially  engaged  my  atten¬ 
tion  as  possible  yellow  fever  germs.  I  shall  also  show  you  cul¬ 
tures  and  photo-micrographs  of  the  micrococcus  presented  to  me 
by  Dr.  Domingos  Freire  of  Brazil  as  his  microbe  of  yellow 
fever,  of  the  tetragonus  febris  flavae  of  Dr.  Carlos  Finlay  of 
Havana,  and  of  the  bacillus  of  Dr.  Paul  Gibier  of  Paris. 

But  I  must  announce  to  you  in  advance  that  there  is  no  sat¬ 
isfactory  evidence  that  any  one  of  these  micro-organisms  is  the 
veritable  infectious  agent  in  the  disease  under  consideration. 

.  I  at  first  hesitated  to  accept  the  invitation  extended  to  me  to 
address  you  on  this  occasion,  inasmuch  as  my  investigations 
have  not  led  to  any  definite  result,  and  as  they  are  still  in  pro¬ 
gress,  and  will  be  continued  in  Havana  during  the  present  sum¬ 
mer.  But  the  importance  of  the  occasion  and  the  solicitation 
of  my  good  friend  Dr.  Cochran,  the  efficient  health  officer  of 
the  State  of  Alabama,  have  induced  me  to  come  here  for  the 


9L 


purpose  of  making  a  brief  statement  relating  to  the  present 
status  of  the  investigation  with  which  I  am  charge*!,  and  espe¬ 
cially  for  the  purpose  of  demonstrating  to  yon  the  methods 
of  research  employed  by  bacteriologists  in  investigations  of 
this  nature. 

I  may  say  before  going  any  further,  that  my  faith  in  a  living 
infectious  agent  as  the  specific  cause  of  this  disease  is  by  no 
means  diminished  by  my  failure  thus  far  to  demonstrate  the 
exact  form  and  nature  of  this  hypothetical  “germ.”  The  pres¬ 
ent  state  of  knowledge  with  reference  to  the  etiology  of  infec¬ 
tious  diseases  in  general,  and  well-known  facts  relating  to  the 
origin  and  spread  of  yellow  fever  epidemics  fully  justify  such 
a  belief.  The  a  priori  grounds  for  such  faith  I  stated  as  long 
ago  as  1873,  in  a  paper  published  in  the  American  Journal  of 
the  Medical  Sciences  (July,  1873);  and  the  progress  of  knowl¬ 
edge  since  that  date  has  all  been  in  the  direction  of  supporting 
this  a  priori  reasoning.  But  yellow  fever  is  by  no  means  the 
only  infectious  disease  in  which  satisfactory  evidence  of  the 
existence  of  a  living  infectious  agent  is  still  wanting.  In  the 
eruption  fevers  generally  no  demonstration  has  been  made  of 
the  specific  etiological  agent — at  least  none  which  has  been 
accepted  by  competent  pathologists  and  bacteriologists.  Again, 
in  the  infectious  disease  of  cattle,  known  as  pleuro-pneumonia, 
notwithstanding  very  extended  researches  by  competent  inves¬ 
tigators  in  various  parts  of  the  world,  no  satisfactory  demon¬ 
stration  of  the  germ  has  been  made.  The  same  is  true  of  hy¬ 
drophobia,  in  which  disease  we  are  able  to  say  with  confidence, 
the  infectious  agent  is  present  in  the  brain  and  spinal  cord  of 
animals  which  succumb  to  rabies;  this  infectious  agent  is  de¬ 
stroyed  by  a  temperature  which  is  fatal  to  known  pathogenic 
micro-organisms  (65 °C),  and  by  various  germicide  agents,  yet 
all  efforts  to  cultivate  it  or  to  demonstrate  its  presence  in  the 
infectious  material  by  staining  processes  and  microscopical  ex¬ 
amination  have  thus  far  been  unsuccessful. 

You  are  aware  that  my  first  effort  to  solve  the  etiology  of  yel¬ 
low  fever  was  made  ten  years  ago.  As  a  member  of  the  Ha¬ 
vana  Yellow  Fever  Commission  of  the  National  Board  of 


92 


Health,  I  had  an  opportunity  to  make  researches  which,  in  ad¬ 
vance  of  the  effort,  I  fondly  hoped  might  lead  to  a  demonstra¬ 
tion  alike  creditable  to  American  science  and  useful  as  a  basis 
for  preventive  and  curative  measures  in  this  pestilential  malady, 
which  has  destroyed  the  lives  of  so  many  of  our  fellow  citi¬ 
zens,  and  has  so  largely  interfered  with  the  material  progress 
of  certain  sections  of  the  United  States.  I  knew  from  personal 
experience  the  malignant  nature  of  the  disease,  and  the  futility 
of  the  various  modes  of  treatment  which  had  been  resorted  to 
in  the  effort  to  combat  it.  It  was  therefore  with  the  deepest 
interest,  as  well  as  with  strong  hopes  of  success,  that  I  went  to 
an  endemic  focus  of  the  disease  to  search  for  the  yellow  fever 
germ.  The  recent  (1873)  demonstration  of  the  spirillum  of 
relapsing  fever  in  the  blood  of  patients  suffering  from  this 
disease,  and  the  recognized  facts  relating  to  the  etiology  of 
anthrax,  considered  in  connection  with  the  current  notions  re¬ 
lating  to  the  pathology  of  yellow  fever,  lead  me  to  hope  that 
the  discovery  would  be  an  easy  one.  I  was  familiar  with  the 
most  approved  methods  of  mounting  and  staining  micro-organ¬ 
isms,  and  was  provided  with  the  best  high  power  objectives 
that  could  be  procured — the  one-twelfth*  and  one-eighteenth 
homogeneous  oil  immersion  objectives  of  Karl  Zeiss,  of  Jena, 
Germany.  Hot  only  did  I  feel  that  I  was  equipped  for  the 
recognition  of  any  micro-organism  which  might  prove  to  be 
present  in  the  blood,  but  I  was  prepared  to  photograph  it,  and 
thus  to  show  to  others  what  I  might  see  in  blood  drawn  from 
the  circulation  of  yellow  fever  patients.  You  know  the  result 
of  this  investigation — “ninety-eight  specimens  from  forty-one 
undoubted  cases  of  yellow  fever  were  carefully  studied,  and 
one  hundred  and  five  photographic  negatives  were  made  which 
showed  satisfactorily  everything  demonstrable  by  the  micro¬ 
scope.”  But  no  micro-organism  was  discovered.  I  shall  pres¬ 
ently  show’  you  upon  the  screen  a  photo-micrograph  of  yellow 
fever  blood,  made  in  Havana  at  the  time  mentioned,  so  that 
you  may  judge  of  the  performance  of  my  Zeiss  one-eighteenth 
inch  objective,  and  have  ocular  evidence  that  no  micro-organism 
demonstrable  by  this  magnificent  lens  was  present  in  it.  I  may 


say  here  that  my  culture  experiments,  made  in  Havana  last 
spring,  in  which  blood  taken  from  one  of  the  cavities  of  the 
heart,  as  soon  as  possible  after  death,  was  introduced  into  va¬ 
rious  nutritive  media,  gave  a  like  negative  result. 

Out  of  ten  cases  in  which  I  made  the  autopsy,  in  the  mil¬ 
itary  hospital  at  Havana,  a  development  of  micro-organ¬ 
isms  occurred  in  two  only.  In  the  exceptional  cases  I  ob¬ 
tained  a  bacillus  which  subsequent  researches  showed  to 
be  identical  with  a  bacillus  constantly  found  in  the  alimen¬ 
tary  canal  of  healthy  persons — Bacterium  coli  commune  of 
Escherich. 

The  absence  of  micro-oruanisms  from  blood  drawn  from 

<  » 

the  finger  during  life,  or  from  the  heart  after  death,  cannot 
however  be  accepted  as  evidence  that  there  are  no  parasitic 
organisms  any  where  in  the  tissues.  The  bacillus  of  ty¬ 
phoid  fever,  for  example,  is  rarely  found  in  the  circulating 
fluid,  although  it  must  be  transported  in  the  blood  current 
to  the  various  organs  in  which  foci  of  growth  are  found 
which  contain  numerous  bacilli.  Such  foci  are  especially 
abundant  in  the  spleen,  but  even  in  this  organ  many  thin 
sections  may  be  made  before  a  single  focus  of  development 
is  encountered. 

Having  failed  to  find  the  yellow  fever  germ  in  the  blood 
we  may  still  admit  that,  as  in  typhoid,  it  is  perhaps  only  to 
be  found  in  the  organs  principally  involved  in  the  morbid 
process.  This  reasoning  has  led  me  to  give  special  atten¬ 
tion  to  an  examination  of  the  liver  and  kidney,  both  by  the 
culture  method  and  by  the  examination  of  thin  sections. 
Both  methods  have  given  me  positive  results  so  far  as  the 
occasional  presence  of  micro-organisms  is  concerned,  but 
both  are  in  accord  in  failing  to  demonstrate  the  constant 
presence  of  any  particular  organism.  In  my  culture  expe¬ 
riments  made  in  Havana  last  year  the  micro-organism  most 
frequently  encountered  was  my  bacillus  a,  already  referred 
to  as  found  in  two  out  of  ten  cases  in  cultures  from  blood 
drawn  from  the  heart.  Naturally  I  have  given  much  atten¬ 
tion  to  this  bacillus,  and  it  was  only  after  an  extended  series 


94 


of  comparative  experiments  that  I  gave  np  the  hope  that  it 
might  be  concerned  in  the  etiology  of  the  disease  under 
consideration.  These  comparative  experiments  forced  me 
to  the  conclusion  that  this  is  the  same  bacillus  as  was  found 
by  Emmerich  in  cholera  cadavers  at  Naples,  and  that  it 
corresponds  with  the  Bacterium  coli  commune  of  Escherich. 

In  my  researches  by  the  method  of  staining  thin  sections 
of  the  tissues  hardened  in  alcohol,  I  have  encountered  sev¬ 
eral  different  micro-organisms ;  but  no  one  of  these  has 
been  found  in  a  series  of  cases.  One,  the  bacillus  of  Lac- 
erda  and  Babes,  I  have  found  only  in  material  brought 
from  Dr.  Lacerda’s  laboratory  in  Brazil,  and  in  two  only 
out  of  nine  cases  represented  by  material  from  this  source. 
In  one  of  my  Havana  cases,  in  which  the  material  was  col¬ 
lected  by  my  friend  Dr.  Burgess,  in  1887,  a  long  bacillus 
was  found  in  the  kidney,  for  the  most  part  in  the  glomeruli. 
In  a  case  in  which  I  made  the  autopsy  in  Havana  last  spring 
a  micrococcus,  grouped  in  fours,  was  found  in  the  kidney. 

Evidently,  if  any  one  of  these  micro-organisms  was  found 
in  a  considerable  series  of  cases,  the  fact  would  be  decided¬ 
ly  significant,  and  would  afford  presumptive  evidence  that 
the  parasitic  organism  found  bore  some  relation  to  the  mor¬ 
bid  process.  But,  even  if  one  and  the  same  micro-organism 
was  found  in  every  case,  the  final  proof  of  its  etiological  im¬ 
port  would  depend  upon  its  isolation  in  pure  cultures  and 
the  production  of  the  characteristic  phenomena  of  the  dis¬ 
eases  in  one  of  the  lower  animals — or  in  the  absence  of  a 
susceptible  animal,  in  man  himself. 

The  method  by  cultivation  is  by  far  the  most  reliable  for 
the  demonstration  of  micro-organisms  which  will  grow  in 
our  culture  media,  for  isolated  cocci,  or  bacilli  might  easily 
escape  observation  when  present  in  small4  numbers,  but 
would  serve  to  start  a  culture.  Thus  the  bacillus  of  typhoid 
fever,  which,  as  stated,  is  not  as  a  rule  found  in  the  blood 
of  the  general  circulation,  and  is  only  found  in  the  spleen 
in  scattered  clumps,  may  be  obtained  from  this  organ,  in 
pure  cultures,  almost  without  fail,  by  introducing  a  small 
quantity  of  splenic  pulp  into  a  suitable  nutritive  medium. 


95 


Moreover,  this  method  enables  us  to  differentiate  micro¬ 
organisms  which  look  alike,  and  which  by  microscopic  ex¬ 
amination  alone  it  would  be  impossible  to  distinguish,  one 
from  another.  This  is  a  fact  now  well  recognized  by  bac¬ 
teriologists,  but  not  generally  appreciated  by  microscopists 
whose  researches  have  been  limited  to  the  staining  and 
mounting  of  sections. 

Both  methods  require  skill  and  practice  in  the  execution, 
and  great  caution  in  drawing  conclusions,  for  there  are  a 
thousand  traps  lying  in  wait  for  the  explorer  in  this  field 

t  *  t*  JL * 

Oi  investigation. 

It  is  for  this  reason  that  pseudo-discoveries  are  so  nu¬ 
merous. 

Especial  care  is  required  in  the  microscopical  examina¬ 
tion  of  stained  preparations  of  yellow  fever  tissues.  One 
encounters  in  the  urinary  tubules,  mingled  with  the  debris 
of  the  desquamated  epithelium,  stained  masses  of  various 
forms  which  often  closely  resemble  cocci  or  bacilli.  These 
I  believe  to  be  fragments  of  nuclear  material.  The  same 
material  is  often  massed  in  the  urinary  tubules  in  the  form 
of  plugs,  which  are  deeply  stained  by  the  aniline  dyes. 

Again,  fragmentation  of  nuclei  of  cells  still  in  position  may 
give  the  impression  of  a  cell  containing  cocci;  and  the  kary- 
iokinetic  figures  found  in  the  cells,  especially  in  the  liver, 
often  resemble  bacilli  so  closely  that  it  is  difficult  to  con¬ 
vince  any  one  not  familiar  with  them  that  they  are  not 
micro-organisms. 

The  “plasma  cells”  of  Ehrlich,  also,  seem  to  have  as 
their  chief  function  the  role  of  deluding  amateur  micro¬ 
scopists  into  the  idea  that  they  have  made  a  discovery. 
They  are  often  very  abundant  in  the  liver  and  in  the  kidney 
of  yellow  fever  cases,  and  so  closely  resemble  zoogloea 
masses  of  micrococci  that  experienced  pathologists  have 
been  deceived  by  them. 

In  addition  to  these  objects  which  resemble  micro-organ¬ 
isms  there  are  dangers  from  the  postmortem  invasion  of 
the  tissues  when  the  autopsy  has  been  delayed  beyond  an 


hour  or  two,  in  the  warm  climates  where  yellow  fever  pre¬ 
vails;  or  even  in  the  preserving  medium,  or  during  the 
process  of  staining. 

My  experiments  made  in  1883,  showed  that  “exposure  to 
ninety-five  per  cent,  alcohol  for  forty-eight  hours  did  not 
kill  the  bacteria  in  broken-down  beef  tea  (old  stock)  and 
pathologists  are  familiar  with  the  picture  presented  by  the 
postmortem  invasion  of  tissues  which  have  been  left  in 
alcohol  which  was  not  strong  enough  to  preserve  them. 

Finally,  inasmuch  as  my  culture  experiments  with  mate¬ 
rial  collected  soon  after  death,  from  the  liver  and  kidney, 
gave  a.  positive  result  in  a  certain  proportion  of  the  cases, 
it  is  evident  that  the  micro-organism  most  frequently  found 
by  this  method — my  bacillus  a — should  occasionally  be  en¬ 
countered  in  stained  preparations. 

The  possibility  remains  that  by  some  method  of  staining 
not  hitherto  employed,  the  specific  infectious  agent  may 
yet  be  demonstrated  in  the  tissues;  but  the  fact  that  my 
culture  experiments  with  material  from  the  liver  and  kidney 
of  ten  cases  failed  to  demonstrate  any  such  specific  microbe 
is  opposed  to  this  view.  We  may,  of  course,  suppose  that 
the  yellow  fever  germ  not  only  requires  special  methods, 
yet  undiscovered,  for  its  demonstration  in  the  tissues,  but 
that  it  will  not  grow  in  the  culture  media  which  I  have  em¬ 
ployed  in  my  researches.  I  would  say  in  reply  to  this  hy¬ 
pothesis  that  all  known  pathogenic  micro-organisms  may 
be  demonstrated  by  the  staining  methods  employed,  and 
that,  inasmuch  as  the  yellow  fever  germ  appears  to  find  a 
favorable  nidus  in  filth  beds  external  to  the  body  I  have 
been  inclined  to  believe  that  like  the  bacillus  of  typhoid 
fever  and  cholera  it  is  not  especially  nice  as  to  the  charac¬ 
ter  of  the  medium  in  which  it  may  develope.  However, 
this  may  be  a  mistaken  idea,  and  I  propose  in  my  future  re¬ 
searches  to  make  use  of  various  culture  media  not  yet  em¬ 
ployed,  and  especially  to  make  cultures  from  the  tissues  and 
the  excreta  in  an  atmosphere  from  which  oxygen  has  been 
excluded;  for  it  may  be  that  like  the  bacillus  of  malignant 


97 


oedema  and  the  bacillus  of  tetanus  the  yellow  fever  microbe 
is  anaerobic. 

While  then,  I  admit  that  by  some  special  method  of  stain¬ 
ing,  or  by  a  modification  of  the  culture  methods  heretofore 
employed,  the  specific  infectious  agent  we  are  in  search  of 
may  yet  be  found  in  the  tissues  of  yellow  fever  patients,  I  feel 
justified  in  saying  that  no  such  demonstration  has  yet  been 
made.  The  negative  results  attending  my  researches  in 
this  direction  have  led  me  to  turn  my  attention  to  the  mi¬ 
cro-organisms  present  in  the  alimentary  canal,  for  the  pos¬ 
sibility  suggests  itself  that  this  may  after  all  be  the  habitat 
of  the  deadly  yellow  fever  microbe,  which  is  capable  of  de¬ 
stroying  life  within  two  or  three  days,  and  that  the  phenom¬ 
ena  of  the  disease  are  not  directly  due  to  its  presence  in  the 
body,  but  result  from  the  absorption  of  a  poisonous  pto¬ 
maine  produced  by  it,  as  appears  to  be  the  case  in  cholera. 

The  famous  English  hygienist  Parkes,  from  the  consider¬ 
ation  of  evidence  relating  to  the  prevalence  of  yellow  fever 
during  a  series  of  years  among  English  troops  stationed  in 
Jamaica  and  elsewhere  within  the  “yellow  fever  zone,”  in 
connection  with  the  sanitary  condition  of  their  barracks, 
arrived  at  the  conclusion  that  yellow  fever  is  a  “foecal 
disease,”  and  there  are  many  facts  relating  to  the  origin 
and  extension  of  epidemics  which  seem  to  support  this 
view — that  is  the  belief  that  the  germ  finds  a  proper  nidus 
in  foecal  matter  external  to  the  body.  If  in  yellow  fever,  as 
in  cholera,  the  infectious  agent  is  located  in  the  alimentary 
canal  of  those  who  fall  sick  with  the  disease,  we  can  readily 
understand  how  it  is  that  new  centres  of  infection  are  de¬ 
veloped,  when  external  conditions  are  favorable,  in  the  lo¬ 
calities  where  imported  cases  have  occurred,  or  as  a  result 
of  the  introduction  to  such  localities  of  fomites. 

This  view  also  accords  with  the  demonstrated  fact  that 
yellow  fever  is  not  directly  communicated  by  the  sick  to 
those  in  attendance  upon  them.  Pathogenic  germs  which 
multiply  in  the  intestine  no  more  endanger  those  who  are 

associated  with  the  infected  individual  than  the  same  micro- 

7 


98 


organisms  cultivated  in  a  suitable  medium  in  a  test  tube 
endanger  the  bacteriologist  who  is  engaged  in  their  study. 

The  possibility  that  the  infectious  agent  in  yellow  fever 
may  have  its  habitat  in  the  alimentary  canal,  occurred  to 
me  several  years  ago,  and  I  determined,  in  advance  of  my 
visit  to  Havana  last  spring,  to  give  special  attention  to  a 
bacteriological  study  of  the  intestinal  contents. 

It  is  well  known  that  the  excreta  of  healthy  persons  con¬ 
tain  a  vast  number  of  micro-organisms  of  various  species, 
and  that  while  some  of  these  appear  to  be  constant,  others 
are  occasional,  and  we  may  say  accidental  tenants  of  the 
human  intestine,  being  introduced,  no  doubt,  with  the  in- 
gesta  and  especially  in  drinking  water. 

Notwithstanding  the  researches  of  Brieger,  of  Bienstock, 
of  Escherich,  of  Yignal  and  others  this  bacterial  flora  of 
the  healthy  intestine  is  still  imperfectly  known.  The  at¬ 
tempt,  therefore,  to  explore  this  field  for  the  purpose  of 
finding  a  specific  microbe  in  any  particular  disease  is  at¬ 
tended  with  very  great  difficulties,  unless,  as  in  cholera, 
this  specific  microbe  occupies  the  field  to  the  exclusion  of 
the  ordinary  bacteria  found  in  the  intestinal  contents. 
Koch  found  his  “comma-bacillus”  almost  in  pure  cultures 
in  the  characteristic  rice-water  discharges  of  cholera  pa¬ 
tients,  and  other  bacteriologists,  following  his  methods, 
have  had  no  difficulty  in  verifying  the  presence  of  the  same 
micro-organism  in  cases  of  cholera  occurring  in  various 
parts  of  the  world.  On  the  other  hand,  extended  compara¬ 
tive  researches,  including  my  own  investigations,  made  in. 
Havana  and  in  Decatur,  show  that  the  “comma  bacillus,” 
or  rather  spirillum,  is  not  found  in  the  alvine  discharges  of 
healthy  persons,  or  in  other  diseases  than  cholera.  If  in 
yellow  fever,  as  in  cholera,  there  was  a  micro-organism  in 
pure  cultures,  or  in  relatively  great  abundance,  capable  of 
growing  in  the  culture  media  which  are  suitable  for  the  de¬ 
velopment  of  a  majority  of  the  known  pathogenic  organ¬ 
isms,  I  ought  to  be  able,  to-night  to  exhibit  to  you  cultures 
and  photo-micrographs  of  this  micro-organism.  But  my 


99 


researches  show  that  the  micro-organism  which  is  by  far 
the  most  abundant,  and  so  far  as  my  investigations  go  the 
only  constant  form  found  in  the  excreta  of  yellow  fever  ca¬ 
ses,  is  the  Bacterium  coli  commune  of  Escherich;  which  is 
also  the  most  constant  and  abundant  form  found  in  the  ex- 
.  creta  of  healthy  persons. 

In  Havana,  my  cultures  were  made  from  material  from  the 
stomach  and  intestine  of  fatal  cases  obtained  at  the  time  of 
making  the  autopsy.  My  researches  did  not  show  that  any  of 
the  micro-organisms  encountered  was  constantly  present  with 
the  exception  of  the  Bacterium  coli  commune — my  bacillus  a. 
Having  excluded  this  bacillus  by  comparative  researches  there 
was  nothing  to  point  to  any  one  of  the  micro-organisms  pres¬ 
ent  in  my  cultures  as  the  probable  infectious  agent  I  was  in 
search  of. 

The  bacillus  of  Dr.  Paul  Gibier  I  only  encountered  in  three 
cases  out  of  ten,  and  in  these  it  was  not  present  in  very  great 
abundance,  compared  with  the  colon  bacillus  for  example. 

My  time  in  Havana,  limited  by  my  orders,  was  too  brief  to 
enable  me  to  make  an  exhaustive  research.  The  epidemic  in 
Florida  and  Alabama  during  the  past  summer  gave  me  an  op¬ 
portunity  to  continue  the  investigation,  and,  at  my  request,  I 
was  directed  to  proceed  to  the  infected  district  for  this  pur¬ 
pose.  The  presence  of  my  friend  Dr.  Jerome  Cochran,  state 
health  officer,  at  Decatur,  decided  me  to  locate  my  laboratory 
in  that  place,  where  I  found  abundant  material  for  the  re¬ 
searches  which  I  had  in  view.  Having  made  a  codsiderable 
number  of  autopsies  in  Havana,  I  determined  while  in  Decatur 
to  devote  my  attention  especially  to  a  bacteriological  study  of 
the  alvine  discharges  collected  during  the  different  stages  of 
the  disease. 

Evidently  if  the  infectious  agent  multiplies  in  the  intestine, 
it  should  be  found  in  the  excreta  during  the  earlier  stages  of 
the  attack. 

The  cause  must  be  present  in  advance  of  the  development' 
of  the  morbid  phenomena  which  characterize  the  disease.  But, 
it  is  quite  possible  that  during  its  later  stages  the  etiological 


100 


agent  has  perished,  and  therefore  would  not  appear  in  cultures 
made  from  material  obtained  post  mortem. 

While  in  Decatur,  and  after  my  return  to  Baltimore,  I  ex¬ 
amined,  by  bacteriological  methods — Esmarch  tubes — the  ex¬ 
creta  of  thirty-nine  cases  of  yellow  fever,  and  for  comparison, 
of  nine  convalescents  and  of  nineteen  healthy  individuals.  A 
detailed  account  of  the  results  reached  will  be  given  in  my 
final  report.  As  was  to  have  been  expected,  I  have  encoun¬ 
tered  a  variety  of  micro-organisms.  Many  of  these  I  have 
isolated  in  pure  cultures  and  the  biological  and  pathogenic 
characters  of  several  have  been  carefully  studied  by  cultivation 
in  various  media  and  by  inoculation  experiments  in  the  lower 
animals.  It  would  be  premature  for  me  to  attempt  to  give 
you  the  results  of  these  researches,  even  if  time  permitted  me 
to  do  so.  But  I  may  repeat  what  I  said  at  the  outset,  that  the 
germ  of  yellow  fever  has  not  yet  been  demonstrated.  It  is 
possible,  however,  that  one  or  the  other  of  the  micro-organisms 
which  I  have  isolated  is  the  long-sought  germ,  although  I  have 
no  satisfactory  evidence  upon  which  to  base  a  claim  that  this  is 
the  case. 

My  attention  has  been  especially  directed  to  the  liquifying 
organisms  found  in  the  excreta  of  the  thirty-nine  cases  exam¬ 
ined.  In  a  majority  of  these  cases  the  presence  of  liquifying 
bacilli  was  demonstrated,  but  liquifying  colonies  .were  not 
numerous  as  compared  with  the  non-liquifying,  among  which 
the  colon  bacillus  of  Escherich  was  bv  far  the  most  abundant. 
In  a  series  of  Esmarch  tubes  No.  1  would  show  numerous  liqui¬ 
fying  centres,  usually  within  twenty-four  hours  ;  very  often  No* 
2  would  contain  a  few  liquifying  colonies;  while  as  a  rule  No. 
3,  although  containing  numerous  isolated  colonies  of  the  colon 
bacillus,  did  not  contain  any  liquifying  colonies.  Further,  I 
found  that  several  different  liquifying  organisms  were  present 
in  different  cases,  or  were  associated  in  the  same  case.  I  shall 
presently  show  you  cultures  and  photo-micrographs  of  these 
liquifying  bacilli.  The  one  most  frequently  present,  my  bacil¬ 
lus  o ,  I  have  since  found  in  cultures  from  another  source  and 
am  obliged  to  exclude  it  as  the  possible  specific  etiological  agent 


101 


of  yellow  lever.  It  lias  also  been  isolated  by  Dr.  Booker, 
of  Baltimore,  from  the  discharges  of  one  or  more  infants 
suffering  from  summer  diarrhoea.  The  bacillus  of  Gibier  I 
have  only  isolated  from  three  cases,  and  in  these  it  was  not 
present  in  considerable  numbers.  I  have  made  extensive 
experiments  upon  the  lower  animals,  which  show  that  this 
bacillus  has  interesting  pathogenic  properties,  but  give  no 
special  support  to  the  view  that  it  is  the  specific  germ  of 
yellow  fever.  I  have  never  observed  in  my  cultures  the 
black  pigment,  which,  according  to  Dr.  Gibier,  is  produced 
during  the  development  of  this  bacillus,  and  am  at  a  loss 
to  understand  this  discrepancy  in  our  observation. 

So  far  as  the  pigment  in  black  vomit  is  concerned, 

I  have  no  doubt  that  it  is  of  haemic  origin.  I  have 
never  failed  to  demonstrate,  by  a  microscopic  examination, 
the  abundant  presence  of  red  blood  corpuscles  in  the  nu¬ 
merous  specimens  of  black  vomit  which  I  have  examined. 
The  little  black  flocculi,  are  in  fact,  made  up  of  agglomerated 
corpuscles  which  have  lost  their  pigment  and  appear  as 
pale  discs,  often  more  or  less  swollen  and  distorted;  while 
the  brownish  pigment,  which  has  been  changed  by  the  acid 
secretions  of  the  stomach,  remains  in  their  vicinity  in  the 
form  of  granules  or  amorphous  masses.  The  idea  that 
there  is  something  specific  about  this  pigment,  or  that  it  is 
the  secretion  of  a  specific  microbe,  as  has  been  maintained 
by  Freire  and  by  Gibier,  appears  to  me  to  be  untenable. 
In  a  majority  of  the  non-fatal  cases  of  yellow  fever,  and  in 
a  certain  proportion  of  the  fatal  cases,  there  is  no  passive 
hemorrhage  into  the  stomach,  and  consequently  no  black 
vomit,  yet  these  cases  must  result  from  the  action  of  the 
same  etiological  agent  as  those  in  which  this  symptom  is 
present. 

I  have  found  by  experiment  that  the  bacillus  of  Gibier, 
the  micrococcus  of  Freire,  and  the  tetragonous  of  Finlay, 
all  grow  after  being  exposed  for  an  hour  to  a  temperature 
of  15°  C.  Exposure  outside  of  the  laboratory  in  Baltimore 
for  five  days  in  the  month  of  January,  failed  also  to  destroy 


102 


the  vitality  of  these  micro-organisms,  although  the  temper¬ 
ature,  during  the  greater  part  of  the  time  at  least,  was  be¬ 
low  the  freezing  point. 

Having  thus  given  you  a  brief  account  of  the  present 
status  of  the  investigation  in  which  I  am  engaged,  I  pro¬ 
pose  to  devote  the  remainder  of  the  time  at  my  disposal, 
to  a  practical  demonstration  of  the  methods  of  research  em¬ 
ployed,  and  to  an  exhibition  upon  the  screen  of  the  various 
micro-organisms  to  which  I  have  referred. 

Note. — The  illustrations  are  necessarily  omitted  here. 


APPENDIX  VIIL 


LEUCOMAINES  AND  PTOMAINES  AND  THEIR  RE¬ 
LATIONS  TO  DISEASE, 

BY 

VICTOR  C.  VAUGHN,  M.  D., 

Professor  of  Hygiene  and  Physiological  Chemistry  in  the  University  of 

Michigan. 


We  may  divide  the  majority  of  internal  diseases  into 
two  classes,  the  autogenous  and  the  infectious. 

By  an  autogenous  disease  we  mean  one  which  originates 
wholly  within  the  body,  and  which  is  the  result  of  disturb¬ 
ances  of  physiological  processes.  All  living  things  absorb 
and  excrete  matter.  In  health  there  is  perfect  adjustment 
between  absorption  and  excretion.  Disturb  this  relation 
either  by  excessive  ingestion,  or  by  imperfect  elimination 
and  disease  more  or  less  marked  results.  The  medical  pro¬ 
fession  can  understand  and  appreciate  the  force  and  im¬ 
portance  of  these  assertions  more  fully  now  than  it  has 
been  able  to  do  at  any  time  in  the  past.  Recent  investiga¬ 
tions  have  shown  us  that  poisons  are  constantly  being  gen¬ 
erated  in  our  bodies,  and  that  in  health  we  escape  their  ill 
effects  by  constant  and  sufficient  elimination.  A  hasty  re¬ 
view  of  some  of  the  recent  knowledge  which  has  been 
gained  on  this  subject  may  not  be  devoid  of  interest. 

Peptones,  which  represent  the  first  known  step  in  the 
breaking  up  of  the  proteid  molecule,  when  injected  directly 
into  the  circulation  act  as  powerful  poisons.  They  destroy 
the  coagulability  of  the  blood,  lower  blood-pressure,  and  in 
large  quantities  cause  speedy  death.  In  health  the  pep- 


104 


tones  formed  during  digestion  do  not  reach  the  general  cir¬ 
culation.  In  the  liver  they  are  robbed  of  their  poisonous 
properties  by  being  converted  into  globulin.  But  it  is  alto¬ 
gether  probable  that  at  times  the  liver  partially  fails  in  this 
function  and  that  the  health  suffers  in  consequence.  This 
may  be  due  to  the  taking  of  excessive  quantities  of  proteids, 
the  digestion  being  active  and  the  peptones  formed  and 
poured  into  the  portal  circulation  faster  than  the  liver  can 
convert  them  into  globulin  ;  or  it  may  be  that  from  lack  of 
exercise  or  other  reason  the  liver  is  tardy  in  its  action,  or 
“torpid”  as  we  say,  and  small  quantities  of  peptones  pass 
into  the  general  circulation.  The  lassitude,  depression, 
feeling  of  weight  in  the  iimbs>  and  dullness  in  the  head  oc¬ 
curring  in  the  well-fed,  inactive  man  after  his  meals,  Brun- 
ton  attributes  to  poisoning  with  peptones.  The  remedy  is 
less  food,  especially  less  nitrogenous  food,  and  more  exer¬ 
cise.  That  some  substances  resulting  from  the  proteids  of 
the  food  is  the  cause  of  the  trouble,  Brunton  thinks,  is  evi¬ 
denced  by  the  fact  that  “the  weakness  and  languor  are  ap¬ 
parently  less  after  meals  conisting  of  farinaceous  food  on- 

ly.” . 

Brieger  obtained  by  digesting  fibrin  with  gastric  juice  a 
substance  which  gives  reactions  with  many  of  the  general 
alkaloidal  reagents,  and  to  which  he  has  given  the  name 
peptotoxine.  A  few  drops  of  a  dilute  aqueous  solution  of 
this  substance  suffice  to  kill  frogs  within  fifteen  minutes. 

Thus,  we  see  that  poisonous  substances,  are  formed  dur¬ 
ing  normal  digestion,  and  that  in  health  we  are  not  affected 
by  them  because  they  are  rendered  inert  by  further  changes 
in  their  structure  or  because  they  are  soon  eliminated. 

Pouchet,  Bouchard  and  others  have  studied  the  basic 
substances  found  in  the  urine,  and  it  has  been  shown  that 
the  poisonous  character  of  this  excretion  is  greater  during 
the  hours  spent  in  work  than  in  those  spent  in  rest.  In 
other  words,  the  more  vigorously  the  physiological  pro¬ 
cesses  proceed,  the  more  rapidly  are  the  physiological  pois¬ 
ons  generated. 


/ 


105 

% 

Brown-Sequard  has  condensed  the  exhaled  air  of  doss, 
and  has  injected  the  liquid  thus  obtained  into  other  ani¬ 
mals,  causing  death.  The  symptoms  observed  were  dilation 
of  the  pupil,  increase  of  the  heart  beat,  slowing  of  the  res¬ 
piration  and  a  fall  in  temperature.  Choleraic  diarrhoea  in¬ 
variably  appeared.  These  symptoms,  it  should  be  remark¬ 
ed,  occurred  when  the  liquid  had  been  boiled  previous  to 
being  injected,  and  consequently  they  could  not  be  due  to  a 
germ.  From  these  results  it  is  evident  that  expired  air  con¬ 
tains  an  extremely  violent  poison,  and  Brown-Sequard  is  of 
the  opinion  that  the  slowly  exercised  influence  of  this  sub¬ 
stance  on  those  living  in  ooorlv  ventillated  houses  has  some- 

.  o  i  1/ 

thing  to  do  with  the  production  of  pulmonary  phthisis. 

These  facts  must  suffice  to  convince  us  that  sufficient 
causes  for  many  diseases  are  to  be  found  in  the  poisons  gen¬ 
erated  within  our  bodies.  A  man  may  drink  only  chemic¬ 
ally  pure  water,  eat  only  that  food  which  is  free  from  all 
adulterations,  and  breathe  nothing  but  the  purest  air  free 
from  all  organic  matter,  both  living  and  dead,  and  yet  that 
man’s  excretions  would  contain  poisons,  and  if  they  are  not 
eliminated  with  sufficient  rapidity  they  will  produce  disease 
and  death.  These  poisons  originate  in  the  metabolic  changes 
by  which  the  complex  organic  molecule  is  split  up  into  sim¬ 
pler  compounds.  We  may  suppose,  indeed,  we  have  good 
reasons  for  believing,  that  the  proteid  molecule  has  certain 
lines  of  cleavage  along  which  it  breaks  when  certain  forces 
are  applied,  and  that  the  resulting  fragments  have  also  lines 
of  cleavage  along  which  they  break  under  certain  influences, 
and  so  on  until  the  end  products,  urea,  ammonia,  carbonic 
acid  gas  and  water  are  formed.  We  know  that  substances 
similar  in  chemical  composition  are  similar  in  their  physi¬ 
ological  actions,  and  some  idea  of  the  virulence  of  these  leu- 
comaines  can  be  formed  when  I  tell  you  that  a  number  of 
them  contain  hydrocyanic  acid  as  a  nucleus. 

It  is  highly  probable  that  many  of  the  nervous  symptoms 
which  accompany  dyspepsia  are  due  to  the  formation  and 
absorption  of  poisonous  substances. 


106 


In  some  persons  the  tendency  to  the  formation  of  poisons 
out  of  certain  foods  is  very  marked.  Thus  there  are  some 
to  whom  the  smallest  bit  of  egg  is  highly  poisonous  ;  with 
others,  milk  will  not  agree ;  and  instances  of  this  kind  are 
sufficiently  numerous  to  give  rise  to  the  adage,  “what  is  one 
man’s  meat  is  another  man’s  poison.” 

That  certain  febrile  conditions  are  autogenous  there  can 
scarcely  be  a  doubt.  These,  like  other  diseases  originating 
within  the  system,  may  be  due  to  either  of  the  following 
causes :  (1.)  There  may  be  an  excessive  formation  of 

poison  within  the  body.  (2.)  There  may  be  deficient  de¬ 
struction  of  poisons  from  incomplete  oxidation  or  other  de¬ 
structive  changes,  as  is  probably  the  case  with  those  living 
in  a  vitiated  atmostphere.  (3.)  There  may  be  undue  re¬ 
tention  of  the  poisons  which  normally  are  eliminated  by  the 
skin,  lungs,  bowels  and  kidneys. 

First,  we  may  mention  fatigue  fever,  which  is  by  no 
means  uncommon,  and  from  which  the  busy  physician  not 
infrequently  suffers.  One  works  night  and  day  for  some 
time  ;  elimination  seems  to  proceed  normally  ;  but  after  a 
few  days  there  is  an  elevation  of  temperature  of  from  one 
to  three  degrees,  the  appetite  is -impaired,  and  then  if  the 
opportunity  for  rest  is  at  hand  sleep  is  impossible.  The 
tired  man  retires  to  his  bed  expecting  to  fall  asleep  imme¬ 
diately,  but  he  tosses  from  side  to  side  all  night,  or  his 
sleep  is  fitful  and  unrefreshing.  The  brain  is  excited  and 
refuses  to  be  at  rest. 

Fatigue  fever  is  frequently  observed  in  armies  upon  forced 
marches,  especially  if  the  troops  are  young  and  raw.  Mosso 
has  recently  studied  this  fever  in  the  Italian  army.  He 
states  that  in  fatigue  the  blood  is  subjected  to  a  process  of 
decomposition  brought  about  by  the  infiltration  into  it  from 
the  solid  tissues  of  poisonous  substances  which,  when  in¬ 
jected  into  the  circulation  of  healty  animals,  induce  malaise 
and  all  the  signs  of  excessive  exhaustion. 

This  fever  is  sometimes  pronounced  malarial,  and  quinine 
is  administered,  but  it  does  no  good,  often  harm,  by  in- 


107 


creasing  cerebral  excitement.  The  proper  treatment  is  pro¬ 
longed  rest  and  possibly  recovery  may  be  hastened  by  the 
proper  use  of  eliminatives. 

Then  there  is  the  fever  of  exhaustion,  which  differs  from 
fatigue  fever  only  in  degree.  It  is  brought  on  by  prolonged 
exertion  without  sufficient  rest,  and  often  without  sufficient 
food.  The  healthy  balance  between  the  formation  and  the 
excretion  of  poisons  is  disturbed,  and  it  may  be  weeks  be¬ 
fore  it  is  re-established — indeed,  it  may  never  be  re-estab¬ 
lished,  for  some  of  these  cases  terminate  fatally.  The  fever 
of  exhaustion  may  take  on  the  typhus  form  ;  delirium  may 
appear,  muscular  control  of  the  bowels  may  be  lost,  and 
death  may  result. 

Between  these  extremes  of  fatigue  fever  and  the  fever  of 
exhaustion  there  may  be  every  degree  of  fever  from  over¬ 
exertion. 

Then  again,  there  is  the  fever  of  non-elimination  which 
all  physicians  of  experience  have  observed.  There  is  a  feel¬ 
ing  of  languor,  the  head  aches,  the  tongue  is  coated,  the 
breath  offensive,  and  the  bowels  constipated.  The  physician 
fears  typhoid  fever,  but  finds  that  a  good  brisk  cathartic 
dissipates  all  the  unpleasant  symptoms  and  the  temperature 
falls  to  the  normal. 

Bouchard  has  shown  that  normal  faeces  contain  a  highly 
poisonous  substance  which  may  be  separated  from  them  by 
analysis,  and  which,  when  administered  to  rabbits,  produces 
violent  convulsions.  He  estimates  that  the  amount  of  pois¬ 
onous  alkaloids  formed  in,  and  excreted  by,  the  intestines 
of  a  healthy  man  each  twenty-four  hours  would  be  quite 
sufficient  to  kill  him  if  it  was  all  absorbed.  He  proposes  the 
term  stercoraemia  for  that  condition  which  results  from  ar¬ 
rest  of  excretion  from  the  intestine. 

It  is  not  supposed  by  any  one  at  present  that  all  the 
symptoms  of  so-called  uraemic  poisoning  result  from  reten¬ 
tion  of  urea  alone,  but  the  urine  contains  substances  a  thou¬ 
sand  fold  more  poisonous  than  urea,  and  these  are  also  re¬ 
tained.  We  take  the  amount  of  urea  retained  as  an  evidence 


108 


of  fit  A  AYfprtf.  of  rlprirrAV  lto^cinao  wn  no  r*  nofimofn  ^llG  o.rwonrtf 

of  this  substance  definitely,  just  as  we  take  the  amount  of 
carbonic  acid  gas  in  the  air  in  making  an  estimate  of  the  ex¬ 
tent  to  which,  it  is  vitiated,  and  not  because  we  believe  that 
either  the  urea  in  the  one  case,  or  the  carbonic  acid  in  the 
other,  is  really  the  dangerous  substance. 

That  the  development  of  infectious  diseases  is  largely  de¬ 
pendent  upon  the  condition  of  the  person  into  whom  the 
germs  are  introduced  is  well  known.  Two  men  may  drink 
of  the  same  water  infected  with  the  germ  of  typhoid  fever 
or  cholera,  and  yet  one  will  have  the  disease  and  the  other 

nrn^  C\  1  yv»  novf  o  r>  rto  flio  norconol  prinofiAyi  i  r>  o 

w  |-/  \_/  •  x  Jt-A.  O  i.  a  1.1  k/  t*  jl-4  o  vy  i  v  j~i  vy  jj  vi  kjw  xa  uj i.  V  vj  ci  u»  ixJ  i_x  xii  C(iV> 

quiring  infectious  diseases  is  fully  recognized.  That  the 
difference  in  susceptibility  may  be  due  to  the  relation  be¬ 
tween  the  formation  and  excretion  of  these  poisons  genera¬ 
ted  within  the  body,  I  think  highly  probable. 

The  foregoiug  may  be  considered  as  a  brief  resume  of 
what  we  know  concerning  the  relations  of  leucomaines  to 
diseases. 

A  leucomaine  may  be  defined  as  a  chemical  substance 
basic  in  character,  which  is  produced  by  the  metabolic 
changes  taking  place  in  our  bodies. 

An  autogenous  disease  may  be  defined  as  one  which  re¬ 
sults  from  the  accumulation  in  the  body  of  poisonous  leuco¬ 
maines. 

I  will  now  discuss  with  equal  brevity  the  relation  of  chem¬ 
ical  poisons  to  the  infectious  diseases. 

That  certain  micro-organisms  are  concerned  in  the  produc¬ 
tion  of  many  of  the  infectious  diseases  there  can  now  be  no 
doubt.  The  rules  given  by  Koch  for  determining  whether 
or  not  a  given  germ  is  the  cause  of  a  certain  disease,  do  not 
admit  of  any  doubt  when  they  are  fully  complied  with.  But 
admitting  that  germs  bear  a  causal  relation  to  the  disease, 
the  question  arises,  how  do  they  produce  disease?  To  this 
question  many  answers  have  been  proposed,  and  the  more 
important  of  these  will  now  be  reviewed. 

(1)  It  was  first  suggested  by  Bollinger  that  apoplectiform 


109 


anthrax  was  due  to  deoxidation  of  the  blood  by  the  bacilli. 
These  germs  are  aerobic,  and  were  supposed  to  deprive  the 
red  blood  corpuscles  of  their  oxygen.  This  theory  was  sug¬ 
gested  most  probably  by  the  resemblance  of  the  symptoms 
to  those  of  carbonic  acid  poisoning.  The  most  prominent 
of  these  symptoms  are  dyspnoea,  cyanosis,  convulsions,  di¬ 
lated  pupils,  subnormal  temperature,  and,  in  general,  the 
phenomena  of  asphyxia.  Moreover,  post-mortem  examina¬ 
tion  reveals  conditions  similar  to  those  observed  after  death 
by  deprivation  of  oxygen.  The  veins  are  distended,  the 
blood  is  dark  and  thick,  the  parenchymatous  organs  are 
cyanotic,  and  the  lungs  are  hyperaemic.  Bollinger  compared 
this  form  of  anthrax  to  poisoning  with  hydrocyanic  acid> 
which  was  then  believed  to  produce  fatal  results  by  robbing 
the  blood  of  its  oxygen. 

This  theory  presupposed  a  large  number  of  bacilli  in  the 
blood,  and  this  accorded  with  the  estimate  of  Davaine, 
which  placed  the  number  at  from  six  to  eight  millions  in  a 
single  drop.  But  more  extended  and  careful  observation 
showed  that  the  blood  of  animals  dead  from  anthrax  is  often 
very  poor  in  bacilli.  Virchow  reported  cases  of  this  kind, 
and  Joffray  found  in  some  of  his  inoculation  experiments 
that  the  animals  died  before  any  bacilli  appeared  in  the 
blood.  These  and  other  investigations  of  a  similar  character 
began  to  cause  workers  in  this  field  of  research  to  doubt 
the  truth  of  the  theory.  These  doubts  were  soon  converted 
into  positive  evidence  against  the  theory.  Qemler  found 
that  the  blood,  even  when  rich  in  bacilli,  still  possessed  the 
bright  red  color  of  oxyhaemaglobin.  Toussaint  caused  ani¬ 
mals  which  had  been  inoculated  with  the  anthrax  bacillus 
to 'breathe  air  containing  a  large  volume  of  oxygen,  and 
found  that  this  did  not  modify  the  symptoms  or  retard 
death.  Finally  Neucki  determined  the  amount  of  physio¬ 
logical  oxidation  going  on  in  the  bodies  of  animals  sick  with 
anthrax  by  estimating  the  amount  of  phenol  excreted  after 
the  administration  of  one  grain  of  benzol,  and  found  that 
the  oxidation  of  the  benzol  was  not  diminished  by  the  dis- 


110 


ease.  Thus,  the  theory  that  germs  destroy  life  by  depriving 
the  blood  of  its  oxygen,  has  been  found  not  to  be  true  for 
anthrax,  and  if  not  true  for  anthrax,  certainly  it  cannot  be 
for  any  other  known  disease.  The  bacillus  anthracis  is,  as 
has  been  stated,  aerobic,  while  most  of  the  pathogenic  germs 
are  anaerobic — that  is,  they  live  in  the  absence  of  oxygen. 
Moreover,  in  many  diseases  the  bacteria  are  not  found  in 
the  blood  at  all.  Lastly,  the  symptoms  of  these  diseases 
are  not  those  of  asphyxia.  These  facts  have  caused  all  bac¬ 
teriologists  to  acknowledge  that  this  theory  is  not  the  right 
one. 

(2.)  If  a  properly  stained  section  of  a  kidney,  taken  from 
a  Guinea  pig  which  has  been  innoculated  with  the  bacillus 
anthracis,  be  examined  under  the  microscope,  the  bacillus 
will  be  found  to  be  present  in  such  large  numbers  that  they 
form  emboli,  which  not  only  close  but  actually  distend  the 
capillaries  and  larger  blood  vessels,  and  interfere  with  the 
normal  functions  of  the  organ.  A  similar  condition  is 
sometimes  found  on  microscopical  examination  of  the  liver, 
spleen  and  lungs.  From  these  appearances  it  was  inferred 
that  the  bacilli  produce  the  diseased  condition  simply  by 
accumulating  in  large  numbers  in  these  important  organs 
and  mechanically  interrupting  their  functions.  This  is 
known  as  the  mechanical  interference  theory. 

Klebs  and  Toussaint  were  formerly  ardent  advocates  of 
this  theory  in  its  application  to  anthrax,  and  the  latter 
thought  that  the  symptoms  and  death  are  due  to  stoppage 
of  the  pulmonary  circulation  by  means  of  emboli.  How¬ 
ever,  Hoffa  studied  this  point  by  making  numerous  post¬ 
mortem  examinations,  and  was  unable  to  confirm  it. 

In  the  majority  of  germ  diseases  this  theory  never  had 
any  support.  There  is  not  found  any  great  accumulation 
of  bacteria  in  any  organ,  and  the  number  and  distribution  of 
the  germs  are  such  that  the  theory  of  mechanical  interfer¬ 
ence  can  not  be  held  at  all. 

(3.)  Another  answer  given  to  the  question,  “How  do 
germs  induce  disease?”  is  that  they  do  so  by  consuming 


Ill 


the  proteids  of  the  body,  and  thus  deprive  it  of  its  susten¬ 
ance.  The  proteids  are  known  to  be  necessary  for  the 
building  up  of  cells,  and  it  is  also  known  that  micro-organ¬ 
isms  feed  upon  proteids.  But  this  theory  is  untenable  for 
several  reasons.  In  the  first  place,  many  of  the  infectious 
diseases  destroy  life  so  quickly  that  the  fatal  effect  can  not 
be  supposed  to  be  due  to  the  consumption  of  any  very  large 
amount  of  proteid.  In  the  second  place,  the  distribution 
of  the  micro-organisms  is  such,  in  many  diseases,  that  they 
do  not  come  in  contact  with  any  large  proportion  of  the 
proteids  of  the  body.  In  the  third  place,  the  symptoms  of 
the  majority  of  these  diseases  are  not  those  which  would 
be  produced  by  withdrawing  from  the  various  organs  their 
food.  The  symptoms  are  not  those  of  general  starvation. 

(4.)  Still  another  theory  which  has  been  offered,  is  that 
the  bacteria  destroy  the  blood  corpuscles  or  lead  to  their 
rapid  disintegration.  But  in  many  of  the  infectious  dis¬ 
eases,  as  has  been  stated,  the  micro-organisms,  although 
very  abundant  in  certain  organs,  are  not  present  in  the  blood 
at  all.  Moreover,  the  disintegration  of  the  corpuscles  is 
not  confirmed  by  microscopical  examination. 

(5.)  Seeing  the  vital  deficiencies  in  the  above  theories^ 
and  being  impressed  by  the  results  obtained  by  the  chemi¬ 
cal  study  of  putrefaction,  bacteriologists  have  been  led  to 
inquire  into  the  possibility  of  the  symptoms  of  the  infec¬ 
tious  diseases  being  due  to  chemical  poisons.  In  investi¬ 
gating  this  theory,  thrpe  possibilities  present  themselves  : 

(a.)  The  micro-organisms  may  be  poisonous  per  se.  In 
order  for  the  conditions  of  this  theory  to  be  fulfilled,  the 
germs  must  be  present  in  the  blood  before  any  of  the  symp¬ 
toms  appear.  But  in  many  of  the  infectious  diseases  the 
micro-organisms  are  not  found  in  the  blood  at  all.  Finally, 
Neucki,  by  chemical  analysis  of  the  substance  of  the  ba¬ 
cillus  anthracis,  has'shown  that  in  some  respects  it  resembles 
vegetable  casein  and  in  others  animal  mucin.  This  “an¬ 
thrax  protein”  is  freely  soluble  in  alkalies  and  the  dilute 
mineral  acids.  It  is  not  poisonous. 


112 


( b .)  The  germs  may  produce  a  soluble  chemical  ferment, 
which,  by  its  action  on  the  body,  produces  the  symptoms 
of  the  disease  and  death.  This  theory  formerly  had  a 
number  of  very  ardent  supporters,  among  whom  might  be 
mentioned  the  late  eminent  scientist,  De  Bary.  But  Pas¬ 
teur  proved  it  false  when  he  filtered  anthrax  blood  through 
earthen  cylinders,  inoculated  animals  with  the  filtrate  and 
failed  to  produce  any  effect.  Neuki  made  a  similar  demon¬ 
stration  when  he  inoculated  a  two  per  cent,  gelatine  pre¬ 
paration  with  the  anthrax  bacillus,  which  liquified  the 
preparation,  and,  on  standing,  the  bacilli  settled  to  the  bot¬ 
tom.  The  supernatant  fluid,  which  was  clear,  alkaline  in 
reaction,  and  contained  dissolved  “anthrax-protein,”  was 
filtered  and  injected  into  animals  without  producing  any 
effect. 

(c.)  The  bacillus  may  produce  a  chemical  poison  by 
splitting  up  pre-existing  complex  compounds  in  the  body. 
This  theory  is  supported  by  analogy,  when  we  remember 
that  the  ordinary  putrefactive  germs  produce  such  chemical 
poisons,  as  has  been  demonstrated  by  the  work  of  Panum 
and  others.  These  poisons  are  ptomaines,  and  the  truth  of 
this  theory  may  now  be  said  to  amount  to  a  positive  demon¬ 
stration.  We  now  expect  to  find  each  specific  pathogenic 
micro-organisms  producing  its  own  characteristic  poison  or 
poisons.  The  evidence  on  this  point  I  will  again  refer  to. 

I  will  now  give  what  appears  to  me  a  correct  definition  of 
an  infectious  disease. 

An  infectious  disease  arises  when  a  specific  pathogenic 
micro-organism,  having  gained  admittance  to  the  body,  and 
having  found  the  conditions  favorable,  grows  and  multiplies 
and,  in  so  doing,  elaborates  a  chemical  poison,  which  in¬ 
duces  its  characteristic  effects. 

The  above  definition  may  be  illustrated  by  typhoid  fever. 
The  specific  germ  of  this  disease  must  be  present. 

In  the  second  place  it  must  find  in  the  individual  the  condi¬ 
tions  suitable  for  its  growth.  Two  men  may  drink  of  the 
same  water  containing  the  typhoid  germ,  one  will  have  the  dis- 


113 


ease,  the  other  will  not.  The  specific  germ  of  typhoid  fever 
is  now  believed  to  be  that  of  Eberth.  In  1885  Breiger  ob¬ 
tained  from  pure  cultures  of  the  typhoid  bacillus  a  toxic 
ptomaine,  which  produced  in  Guinea-pigs  a  slight  flow  of  saliva, 
frequency  of  respiration,  dilatation  of  the  pupils,  profuse  diar¬ 
rhoea,  paralysis  and  death  within  from  twenty-four  to  forty- 
eight  hours.  Post  mortem  examination  showed  the  heart  in 
systole,  the  lungs  hyperaemic,  and  the  intestines  contracted  and 
pale.  This  substance  Breiger  considers  the  specific  poison  of 
typhoid  fever,  and  calls  it  typho-toxine. 

In  1887  Mr.  Hovy  and  the  writer  obtained  by  inoculating 
beef-tea  with  a  germ  found  in  drinking  water  which  had  been 
the  supply  of  many  persons,  who  had  typhoid  fever,  an  extract 
whieh  when  injected  under  the  skin  of  cats  caused  an  elevation 
in  temperature  of  from  two  to  four  and  one-half  degrees. 

In  one  sick  with  typhoid  fever  the  bacillus  grows  and  multi¬ 
plies  in  the  intestines  and  forms  the  poison,  the  absorption  of 
which  is  followed  by  the  rise  in  temperature  and  other  symp¬ 
toms.  The  lesions  in  the  intestines  are  probably  due  to  the 
bacteria  themselves,  or  possibly  to  the  local  irritating  effect  of 
the  ptomaine. 

There  are  many  reasons  for  believing  that  cholera  infantum 
is  sometimes  at  least  due  to  poisoning  by  tyrotoxicon.  The 
fact  that  infants  nourished  exclusively  from  the  mother’s  breast 
are  almost  wholly  exempt  from  the  disease,  strengthens  this 
belief.  The  symptoms  induced  by  the  poison  agree  with  those 
observed  in  the  disease,  and  the  post  mortem  changes  are  iden¬ 
tical.  Cholera  infantum  is  a  disease  of  the  summer  months, 
when  decomposition  in  milk  goes  on  most  readily.  It  is  most 
common  in  cities  and  among  classes  which  can  not  obtainfresh 
milk  or  have  not  the  means  necessary  to  keep  it  fresh.  The 
milk  is  often  allowed  to  stand  in  a  foul  atmosphere,  from  which 
it  readily  absorbs  the  gases  and  the  germs  of  putrefaction. 
Even  in  country  places  insufficient  attention  is  given  to  the 
care  of  milk.  Cows  stand  and  are  milked  in  filthy  barns.  The 
udders  are  generally  not  washed  before  the  milking,  and  the 
vessels  for  the  milk  are  frequently  not  as  clean  as  they  should 
be.  There  can  be  no  doubt  that  greater  care  given  to  the  milk 
fed  to  infants  will  result  in  the  saving  of  manytlives. 


APPENDIX  IX. 


THE  SANITARY  INSPECTION  SERVICE  AT  HA- 
YANA,  ISLAND  OF  CUBA, 

BY 

DANIEL  M.  BURGESS,  M.  D., 

Sanitary  Inspector  M.  H.  S.  at  that  Port. 


The  proximity  of  Havana  to  the  United  States,  with  its 
large  and  active  commerce,  and  the  fact  that  it  is  an  endemic 
focus  of  the  pestilential  disease,  yellow  fever,  which  in  its  epi¬ 
demic  extension,  has  so  frequently  scourged  our  southeru  sea¬ 
ports,  gives  special  importance  to  the  Sanitary  Inspection  Ser¬ 
vice. 

This  service,  in  connection  with  inspection,  disinfection,  &c., 
at  the  port  of  arrival  and  the  sanitary  measures  enforced  on 
board  vessels  while  in  transit,  constitutes  the  line  of  defense, 
which  is  at  present  depended  upon  for  the  exclusion  of  yellow 
fever  during  the  dangerous  months. 

This  is  the  modern  method  of  sanitary  supervision,  endorsed 
by  the  latest  International  Sanitary  Conference — that  of  Rome 
in  1885 — and  the  results  attained  may  properly  be  compared 
with  those  of  the  method  which  it  has  largely. replaced,  viz : 
a  quarantine  of  detention  at  the  port  of  arrival,  without  any 
special  supervision  of  vessels  at  the  port  of  departure  and  dur¬ 
ing  transit. 

It  is  a  matter  of  history,  that  prior  to  the  late  war,  yellow 
fever  epidemics  occurred  in  certain  of  our  southern  sea-ports, 
New  Orleans,  Pensacola,  Savannah,  Charleston,  &c.,  so  fre¬ 
quently  as  to  give  rise  to  the  opinion,  among  many  physicians 
practicing  in  those  cities,  that  the  disease  was  of  local  origin, 


115 


and,  consequently,  that  all  quarantine  restrictions  were  useless. 

The  fact,  that  there  has  been  no  epidemic  of  yellow  fever  in 
New  Orleans  since  1878,  and  none  in  Charleston  since  1874, 
and  none  in  Savannah  since  1876,  is  a  sufficient  refutation  of 
the  local  origin  idea,  if  there  is  any  one  in  those  cities  who  still 
entertains  it.  That  this  happy  exemption,  for  a  series  of  years, 
in  those  cities  in  which  epidemics  were  formerly  of  almost  an¬ 
nual  occurrence,  is  due  to  the  measures  of  protection  enforced, 
and  not  to  a  change  in  local  conditions,  scarcely  admits  of 
question. 

In  complying  with  the  kind  invitation  of  the  state  health 
officer  of  Alabama,  to  contribute  something  on  the  subject  of 
Sanitary  Inspection  of  Vessels,  &c.,  for  the  consideration  of 
this  important  Conference,  I  would  say,  that  it  is  the  object  of 
the  present  paper  to  give  an  account,  as  nearly  as  I  can,  of  the 
protective  measures  practiced  at  the  port  of  departure  (Havana); 
and  when  the  facts  are  fully  known,  it  will  no  doubt  be  con¬ 
ceded  by  sanitarians,  that  this  sanitary  inspection  service  is  a 
most  important  factor  in  our  system  of  defense. 

Indeed,  an  inefficient  execution  of  the  inspective  service 
here  would  make  the  whole  system  unreliable,  especially  as  re¬ 
gards  the  routes  via  some  southern  ports,  for  by  these  routes  a 
passenger  may  be  landed  in  Charleston  or  Savannah  within 
three  days  of  the  time  of  his  departure  from  Havana.  As  this 
time  is  less  than  the  ordinary  incubative  period  of  the  disease, 
it  is  evident  that  unrestricted  travel  would  open  wide  a  door  by 
which  yellow  fever  might,  any  day  during  the  dangerous  sea¬ 
son,  be  introduced  into  cities  which  by  their  location  are  espe¬ 
cially  susceptible  to  the  disease,  and  by  their  long  exemption 
from  an  epidemic  have  a  population,  which  does  not  to  any  con¬ 
siderable  extent  enjoy  immunity  from  it. 

It  will  be  seen  that  the  restrictions  which  suffice  for  the  ex¬ 
clusion  of  the  disease  from  the  port  of  New  York,  for  instance, 
which  is  nearly  five  days  by  sea  distant  from  Havana,  and  is 
prepared  to  take  charge  of  infected  ships,  or  of  cases  of  the 
disease,  without  special  danger  to  the  community,  might  be 
quite  inadequate  by  routes  through  the  southern  or  Gulf  States. 


116 


Accordingly,  these  restrictions  have  been  made  much  more 
rigid  as  regards  these  routes  ;  restrictions  embracing  nearly 
everything,  that  is  known  to  modern  maritime  sanitation,  in¬ 
cluding  health  certificates,  etc. 

The  method  of  practicing  them  is  more  or  less  as  follows  : 

With  the  idea  of  respecting  the  generally  entertained  belief 
that  the  damper  night  atmosphere  is  more  conducive  to  the 
spread  of  the  specific  cause  of  yellow*  fever  than  the  day,  and 
desiring  to  pay  deference,  to  the  opinion  of  some  bacteriolo¬ 
gists,  that  the  sun-light  is  a  powerful  germicide,  these  vessels 
are  not  allowed  to  enter  the  harbor  of  Havana  until  after  sun¬ 
rise  and  must  leave  it  before  sunset  of  the  same  day,  never 
remaining  in  port  over  night. 

They  come  in  and  sail  out  of  the  harbor  to  the  windward 
of  the  city,  and  during  their  stay  in  it,  they  are  moored  to 
buoys  (not  using  their  anchors)  in  the  open  bay,  remote  from 
other  vessels,  far  to  the  windward  of  the  city,  and  centers  of 
population,  and  in  the  direction  of  the  prevailing  northeast 
trade  wind. 

The  immense  importance  in  a  sanitary  point  of  view  of  the 
location  of  a  vessel  in  the  harbor  of  Havana,  and  the  great 
difference  of  risk  of  infection  to  crew,  vessel  and  cargo,  in  con¬ 
sequence  of  its  position  and  movements  while  there ;  as  to 
whether  it  goes  to  and  lays  at  and  near  wharves,  or  remains 
always  in  the  open  bay,  will  at  once  be  recognized  when  the 
statistics  in  relation  to  these  facts  are  known. 

These  relate  to  the  year  ending  June  30,  1888,  and  the 
eight  years  immediately  previous  or  beginning  in  1879.  They 
comprise  only  those  vessels  which  went  to  ports  in  the  United 
States,  and  the  tables  are  formulated  with  reference  to  locality 
in  harbor,  number,  number  infected  and  proportion. 

The  following  table  gives  the  statistical  port  history  of  548 
vessels  for  the  year  ending  June  30,  1888 : 


117 


« 


TABLE — 548  Vessels. 


Vessels. 


Number 


Infected 


Proportion 

infected. 


Which  were  only  in  open  bay 


347 


Which  were  at  wharves  on  Havana  side- of 

harbor . .  151 

At  wharves  on  opposite  side  of  harbor, 

Regia  and  Casa  Blanca .  50 


0 


0  in  347 


15  1  in  10 
2  1  in  25 


This  table  shows  that  out  of  347  vessels  bound  to  ports  in 
the  United  States,  which  entered  the  harbor  of  Havana  during 
the  year  ending  June  30th,  1888,  and  which  remained  in  the 
open  bay,  not  one  had  yellow  fever  occur  on  board,  while  out 
of  151  which  went  to  wharves  on  the  Havana,  or  city  side  of 
harbor,  15  or  one  in  ten  were  known  to  have  had  yellow  fever 
occur  among  their  crews  ;  and  of  the  remaining  50  which  went 
to  wharves  on  the  opposite  side  of  the  harbor,  as  Casa  Blanca 
and  Regia,  only  two  were  infected,  or  one  in  twenty  five. 

This  proportion  of  risk  corresponds  closely  to  that  of  the 
eight  previous  years,  which  embraced  the  port  history  of  4,852 
vessels  bound  from  Havana  to  ports  in  the  United  States,  and 
gives  us  a  list  of  218  infected  vessels. 

Table  for  Eight  Years  preceding  June  30th,  1887. 


Vessels. 

Number 

Number 

Infected 

- - -  . ' '  ■-  . 

Prop’  rtion 
infected. 

Which  were  only  in  open  bay . 

2,983 

6 

1  in  500 

Which  were  at  wharves  on  Havana  side  of 

harbor . 

1,246 

173 

1  in  7 

On  opposite  of  harbor,  Regia  and  Casa 
Blanca . 

623 

39 

1  in  16 

Total  . 

4,852 

218 

By  that  table  it  is  seen  that  out  of  nearly  3,000  vessels 
which  visited  this  port  during  eight  years  and  left  for  the  Uni¬ 
ted  States,  and  which  remained  in  the  open  bay,  only  six,  or  one 
in  five  hundred,  had  yellow  fever  occur  aboard,  while  of  1,246 
that  went  to  wharves  on  the  Havana  or  city  side  of  the  harbor, 


118 


173,  or  one  in  seven  had  yellow  fever,  and  of  the  623  that 
went  to  the  Regia  and  Casa  Blanca  wharves,  on  the  opposite 
side  of  the  harbor,  thirty-nine  became  infected,  or  one  in  six¬ 
teen. 

It  should  be  stated  here  that  the  six  vessels  which  had  yellow 
fever  occur  aboard  while  remaining  only  in  the  open  bay,  were 
brought  in  close  proximity  to,  or  surrounded  by  other  vessels 
which  had  become  infected  at  wharves  and  afterward  had 
taken  an  anchorage  in  the  open  bay. 

These  statistics  then  prove  conclusively  that,  as  a  rule,  ves¬ 
sels  in  the  open  bay  of  the  port  of  Havana,  and  remote  from 
others,  do  not  become  infected  by  yellow  fever,  and  that  ves¬ 
sels  on  which  practical  exemption  from  it  is  desired,  must  be 
limited  in  their  movements  to  such  localities.  Hence,  the  class 
of  vessels,  by  them  alluded  to,  are  restricted  in  their  move¬ 
ments  to  the  open  bay,  and  never  approach  wharves. 

Ho  person  is  allowed  to  go  aboard  of  the  vessels  referred  to 
without  a  permit  from  the  sanitary  inspector,  and  no  passenger 
can  purchase  a  ticket  or  take  passage,  who  has  not  a  health  cer¬ 
tificate  from  said  inspector.  This  certificate  sets  forth  that  he 
is  acclimated  to  yellow  fever,  either  by  a  previous  attack,  or 
by  a  continuous  residence  of  several  years,  five  or  more,  in 
towns  and  cities  habitually  subject  to  it  in  an  epidemic  form, 
or  where  it  usually  prevails  endeniically,  and  who  has  passed 
through  at  least  one  severe  epidemic ;  or  that  he  is  a  native  of 
places  frequently  visited  by  it,  and  that  there  is  practically  no 
danger  of  his  conveying  the  disease. 

In  cases  of  applicants  for  health  certificates  in  whom  the 
inspector  personally  knows  the  above  conditions  to  exist,  and 
that  by  virtue  of  them  the  person  enjoys  immunity  from  yellow 
fever,  there  is  no  reason  why  a  certificate  to  that  effect  should 
not  be  given  at  once — or  in  other  words  his  health  certificate. 

But  there  are  numerous  cases  which  present  themselves  for 
a  certificate,  in  which  the  inspector  in  order  to  satisfy  himself 
that  the  conditions  required  exist,  has  to  adopt  methods  of  in¬ 
vestigation  to  corroborate  even  the  sworn  statement  of  the  ap¬ 
plicant,  and  the  details  are  very  much  as  follows  : 


119 


Applicants  for  “health  certificates’’  in  Havana  can  for  con¬ 
venience  be  divided  into  four  classes,  viz :  Foreigners,  Spani¬ 
ards,  foreigners  who  are  natives  of  places  where  yellow  fever 
occurs  frequently  and  endemically,  and  Cubans. 

First-class  •  as  to  foreigners. — Their  own  statements  as  to 
length  of  time  passed  continously  in  places  subject  to  yellow 
fever  as  well  as  having  had  the  disease,  &c.,  must  be  sup¬ 
ported  by  the  following  documentary  evidence.  Their  cedulas 
(a  paper)  which  give  a  personal  description  of  them,  their  age, 
nativity,  profession,  and  the  place  where  they  habitually  reside 
and  passports,  also  certificate  of  the  consul  of  their  nation,  to 
the  effect  that  to  his  knowledge  they  have  made  correct  state¬ 
ments  ;  certificate  of  some  well-known  and  respectable  busi¬ 
ness  house  or  banking  institution  that  they  are  reliably  in¬ 
formed  of  the  length  of  time  the  applicant  has  passed  in  the 
tropics,  and  where,  and  as  to  his  having  had  yellow  fever. 

If  he  claims  to  have  had  the  disease  in  question,  the  legalized 
certificate  of  the  physician  who  attended  him  must  be  pro’ 
duced,  or  in  case  he  had  it  in  a  hospital  the  certificate  of  the 
director  of  the  hospital.  In  addition  the  person  is  questioned 
closely  and  cross-questioned  in  regard  to  the  symptoms  he  had 
when  taken  sick,  and  throughout  his  illness  how  he  felt  and 
suffered,  in  what  town  he  lived  at  the  time,  and  who  attended 
him,  how  he  was  nursed,  and  other  questions,  which  the  in¬ 
vestigation  suggests,  are  put. 

Second-class  /  as  to  Spaniards. — They  must  produce  the  doc¬ 
uments  which  identify  them ;  such  as  cedulas,  passports,  &c. 

The  certificate  of  the  inspector  of  vessels  stating  the  time 
when  they  arrived  on  the  island. 

Another  certificate  from  the  alcalde  of  the  ward  in  which 
they  live,  saying  how  long  they  have  lived  there,  and  in  case 
of  removal  that  of  other  alcaldes,  &c.  Also  certificate  of  some 
respectable  mercantile  or  banking  house  stating  how  long  they 
have  lived  in  Cnba,  or  other  provinces,  and  in  what  places.  If 
the  applicant  claims  to  have  had  yellow  fever,  the  certificate 
of  the  physcian  who  attended  him,  or  that  of  the  hospital  in 
which  he  may  have  passed  through  it,  must  be  produced  with 
the  proper  seal  attached. 


120 


He  is  questioned  as  in  the  case  of  class  first,  what  symptoms 
he  had,  &c.,  when  he  was  sick  from  it,  and  in  some  cases  satis¬ 
factory  answers  are  given  which  assist  in  making  a  decision. 

Third-class  •  foreigners  from  a  country  or  locality  where 
yellow  fever  exists  in  an  endemic  form  or  habitually . — The 
certificate  of  his  consul  stating  that  he  has  lived  in  such 
places  continuously  for  many  years  or  is  a  native  of  them,  or 
and  in  addition  the  certificate  of  a  commercial  or  banking 
house  of  good  reputation,  stating  how  long  he  has  lived  in 
those  localities,  and  that  he  is  a  native  of  them. 

Fourth-class  •  when  the  applicant  is  a  Cuban. — He  must 
present  his  cedula  for  his  personal  identification,  which  also 
must  state  where  he  was  born,  his  age,  and  where  he  lives. 
Also  a  certificate  from  the  alcade  of  the  ward  where  he  re¬ 
sides,  saying  how  long  he  has  lived  in  the  ward  and  city. 
Furthermore,  a  certificate  from  some  thoroughly  respectable 
and  reliable  source  that  he  has  lived  more  than  five  consecutive 
years  in  one  of  the  sea-ports  of  the  island.  All  questions  per¬ 
tinent  to  the  examination  must  be  answered  candidly,  upon 
honor,  or  if  deemed  necessary,  under  oath. 

The  above  methods  are  pursued  with  all  the  vigor  that  the 
case  under  investigation  may  require,  until  the  sanitary  in¬ 
spector  feels  himself  reasonably  justified,  in  giving  or  refusing 
to  grant  the  health  certificate.  While  not  a  few  are  refused  it 
is  a  source  of  satisfaction  to  be  assured  that  among  the  several 
thousands  who  have  received  the  health  certificate  and  have 
gone  to  ports  in  the  United  States  in  not  one  instance  has 
yellow  fever  developed  afterward. 

This  fact  is  of  service  in  confirming  the  correctness  of  the 
opinion  that  the  passengers  were  protected  from  yellow  fever. 

When  small-pox  exists  at  any  place  on  the  island  these 
health  assurance  certificates  also  certify  that  the  individual 
from  that  place  is  protected  from  that  disease,  by  a  former  at¬ 
tack  of  it,  or  by  successful  vaccination.,  and  that  the  inspector 
has  re-vaccinated  the  individual. 

Persons  who  have  never  had  small-pox  or  been  successfully 
vaccinated,  are  now  vaccinated  and  detained  six  or  seven  days 


121 


to  observe  the  result  of  the  vaccination,  and  if  this  proves  to 
be  successful  he  gets  his  certificate,  but  if  not  successful  he  is 
vaccinated  again  and  given  a  certificate  to  that  effect,  and  that 

,  he  is  considered  safe.  It  is  but  just  to  say  in  this  connection 

that  no  person  has  been  known  to  fall  sick  with  small-pox  after 
getting  such  a  certificate. 

,  To  prevent  fraud,  exchange  of  certificates,  and  impositions, 

a  system  of  personal  description  forms  part  of  the  health  cer¬ 
tificate  for  some  routes,  and  the  passenger  is  confronted  aboard 
by  the  inspector  with  the  certificate.  Dirty  persons  are  re¬ 
quired  to  take  a  bath  before  going  aboard.  The  baggage  of 
passengers  must  not  only  be  clean  but  be  known  to  come  from 
houses  and  hotels  in  which  there  is  no  yellow  fever  or  it  will 
not  be  received  aboard.  These  houses  are  visited  to  ascertain 
the  fact.  As  soon  as  the  baggage  is  aboard  each  article  is 
taken  out  and  separately  sprayed  over  with  a  solution  of  bi¬ 
chloride  of  mercury  I  part  to  1,000,  and  trunks  and  other  re¬ 
ceptacles  for  it,  which  have  been  treated  in  the  same  man¬ 
ner  are  put  in  the  close,  clean,  hold,  and  fumigated  by  the 
dioxide  of  sulphur,  burning  in  the  process  from  three  to  five 
pounds  of  sulphur  to  each  1,000  cubic  feet.  When  sulphur 
only  is  used  for  disinfecting  baggage,  &c.,  the  articles  are  hung 
up  or  laid  loosely  around  so  that  the  sulphurous  acid  gas  can 
reach  all  parts  of  them.  The  vessel  then  without  any  particu¬ 
lar  detention  can  and  usually  does  proceed  to  sea  while  the 
sulphur  fumigation  is  going  on,  the  hold  remaining  closed  as 
long  as  possible,  eight  hours,  or  more. 

*  No  bedding  of  any  description  is  received,  or  upholstered 
furniture,  or  furniture  of  any  kind,  unless  it  is  absolutely  new, 
is  taken  aboard.  No  article  which  can  reasonably  be  suspected 

•  of  being  fomites  for  the  conveyance  of  yellow  fever  is  allowed 
to  be  shipped  as  freight. 

The  vessels  are  thoroughly  inspected  each  trip,  in  holds, 
engine  and  fire  rooms,  bilge-spaces,  water-closets  and  urinals, 
and  spaces  under  and  around  them,  fore-castle,  glory-hole, 
galley,  pantry,  cupboards,  drawers,  and  recesses,  wash-rooms, 
officers-rooms,  state-rooms  and  cupboards  in  them,  apart- 


122 


ments  for  second-class  passengers,  and  such  conveniences  as  may 
be  provided  for  them,  the  bedding  of  the  ship,  the  condi¬ 
tion  of  decks,  and  other  surfaces,  in  short,  all  parts  of  the  ship. 
Good  ventilation  in  all  apartments  must  be  maintained  (when 
fumigation  is  not  going  on)  by  all  the  means  made  for  that 
purpose  in  the  construction  of  the  vessel  and  by  wind-sails. 

When  the  quarantine,  or  dangerons  season  begins,  the  car¬ 
pets  and  heavy  woolens  of  winter  use  are  removed. 

Although  the  use  of  the  best  disinfectants  and  germicides 
known,  is  continued  all  winter,  at  this  time  they  are  resorted 
to  systematically  and  in  much  greater  quantity. 

All  bedding,  &c.,  in  the  officers  and  crews  apartments  are, 
beside  the  necessary  washing,  taken  out  and  aired  at  least  once 
a  week,  when  the  ceilings,  walls  and  floors  and  all  surfaces  of 
the  rooms  are  sponged  over  or  wet  down  with  the  usual  mer¬ 
curic  solution  of  1  part  to  1,000,  and  washed  with  fresh  water 
and  soap. 

State-rooms  and  all  apartments  for  passengers  are  washed 
and  treated  in  the  same  way  twice  a  week,  or  always  after  a 
trip  to  Havana,  and  bedding  washed,  cleaned  and  aired. 
All  urinals,  as  well  as  apparatus  for  holding  them,  are  kept 
thoroughly  clean  and  frequently  washed  with  a  solution  of 
chloride  of  lime  or  zinc. 

All  other  apartments  in  the  vessel  are  treated  in  a  similar 
manner. 

All  water-closets  are  washed  two  or  three  times  daily,  and 
much  oftener  if  necessary,  employing  at  this  time  the  stand¬ 
ard  solution  of  chloride  of  lime,  or  a  strong  solution  of 
chloride  of  zinc.  Decks  and  some  of  the  thicker  and  more 
exposed  wooden  floors  are  holy-stoned  frequently,  chloride  of 
lime  being  used  in  the  process. 

The  bilges  and  bilge-spaces  are  cleaned  and  sponged  out 
every  week,  and  treated  twice  a  week  alternately  with  solutions 
of  bichloride  of  mercury  and  chloride  of  lime. 

The  hold  is  also  whitewashed  weekly. 

The  engine-room  is  kept  clean,  and  the  bilge  underneath  is 
cleaned  every  week,  and  treated  by  disinfectants,  while  every 


123 


two  days  clean  sea  water  is  run  through  the  bilge-spaces  and 
pumped  out. 

As  far  as  practicable  the  officers  and  crews  of  these  vessels, 
,  are  composed  of  acclimated  persons,  who  are  prohibited  from 
going  ashore,  or  visiting  vessels  in  the  harbor,  without  a  special 
permit  from  the  sanitary  inspector,  and  they  are  individually 
«  examined  before  the  vessel  leaves  the  harbor  for  a  port  in  the 
United  States. 

Not  one  of  them  has  ever  been  found  in  the  least  suffering 
from  any  infectious  disease  now  over  four  years.  In  the  light 
of  what  is  known  of  practical  disinfection,  and  the  prevention 
of  a  vessel  becoming  invaded  by  infective  disease,  it  is  difficult 
to  see  how  much  more  could  be  done,  as  the  methods  above 
mentioned  comprise  about  all  that  is  regarded  as  most  useful 
in  modern  maritine  sanitation.  To  enable  the  sanitary  in¬ 
spector  at  Havana  to  be  one  of  the  agents  in  enforcing  these 
restrictions,  they  must  not  only  be  required  by  the  port  au¬ 
thorities  at  the  vessels  destination,  but  desired  by  the  agents, 
the  owners,  and  those  interested  in  her  welfare.  Such  has 
been  the  case  in  regard  to  some  steamers,  and  such  restrictions 
have  enabled  them  to  continue  in  active  service,  without  one  of 
their  crew  or  one  of  their  passengers  ever  suffering  from  in¬ 
fectious  disease,  or  any  reasonable  suspicion,  or  proof  that  they 
have  in  any  instance  conveyed  the  specific  morbific  cause  of 
yellow  fever. 

It  is  not  pretended  that  the  foregoing  restrictive  methods 
can,  are,  or  need  be  carried  out  in  the  harbor  of  Havana  for  the 

*  security  of  all  ports  in  the  United  States,  and  particularly  in 
winter. 

The  authorities  in  Havana,  are  probably,  as  in  most  other 

•  ports,  very  sensitive  to  and  jealous  of  any  approach  to  or  as¬ 
sumption  of  jurisdiction. 

We  have  no  treaty  with  Spain,  by  virtue  of  which  an 
United  States  sanitary  inspector  is  invested  with  any  par¬ 
ticular  authority.  He  can,  however,  do.  very  much  to  assist  in 
preventing  the  introduction  of  infectious  diseases  into  the 
United  States  by  ships,  because  of  the  maratime  and  sanitary 


124 


regulations  of  the  ports  of  entry,  and  of  the  moral  support 
afforded  by  the  consul  general  of  the  United  States,  and  the 
still  more  important  assistance  of  the  authorities  in  Washing¬ 
ton  ;  and  in  case  of  danger,  he  can  sound  the  note  of  warning. 

The  bill  of  health  which  all  vessels  should  and  are  expected 
to  carry  ds  the  consular  bill  of  health,  and  is  made  out  and 
signed  by  the  sanitary  inspector  as  well  as  by  the  consul.  Such 
information  is  given  in  the  document  as  will  assist  the  health 
authorities  at  the  port  of  entrance,  in  forming  an  opinion  of 
the  sanitary  status  of  the  vessel  and  port  from  which  she  sails, 
and  will  aid  in  determining  what  treatment  she  should  receive. 
It  comprises  the  sanitary  history  of  the  ship;  her  sanitary 
condition  ;  what  her  exposures  have  been  in  the  harbor  from 
which  she  proceeds ;  what  has  happend  to  her  there ;  what 
measures  have  been  taken,  if  any,  to  improve  her  sanitary 
state ;  sanitary  condition  of  cargo,  if  she  carries  any,  and  when 
she  has  ballast,  what  kind,  and  where  taken  in ;  sanitary  condi¬ 
tion  of  crew  and  passengers — stating  whether  they  have  had 
sickness  or  not ;  the  existence  in  the  port  of  infectious  diseases 
as  yellow  fever,  asiatic  cholera,  plague,  small- pox,  or  typhus 
fever ;  how  many  cases,  and  how  many  weekly  deaths  from 
them,  &c. ;  and  all  pertinent  information  which  may  assist  the 
health  authorities  at  the  port  of  destination. 

To  enable  the  inspector  to  state  intelligently  as  to  the  truth 
of  what  he  certifies,  it  is  clear  that  he  must  visit  and  inspect 
the  vessel  and  examine  the  crew.  Captains,  agents  and  owners 
now  understand  this,  and  ask  him  to  go  aboard  and  do  what¬ 
ever  is  necessary,  that  they  may  be  provided  with  the  bill  of 
health.  When  the  inspector  is  invited  aboard  it  is  apparent 
there  can  be  no  well  founded  complaint  of  assumption  of  juris¬ 
diction,  however  foreign  the  vessel  may  be. 

He  then  inspects  the  vessel  in  all  parts,  hold,  bilge,  the 
dunnage  ballast,  water-closets,  forecastle,  cabin,  &c.,  and  in¬ 
dicates  what  should  be  done. 

In  some  instances  he  is  asked  what  can  be  done  to  make  the 
vessel  more  acceptable  to  the  health  authorities  at  the  port  of 
destination. 


125 


There  are  quite  a  number  of  lines  which  are  not  only  willing 
but  anxious  to  do  everything  reasonable  within  their  power  to 
prevent  yellow  fever  getting  aboard,  or  if  there  is  danger  of  its 
being  aboard  in  fomites  to  disinfect  and  destroy  the  infectious 
agent  at  once. 

Such  lines  as  Ward’s,  Morgan’s,  Plant’s  and  Alexander’s,  are 
excellent  examples.  They  not  only  keep  their  vessels  away 
from  wharves  and  dangerous  places,  but  are  willing  to  cleanse 
and  to  use  disinfectants  in  their  vessel,  cargo,  ballast,  bilge,  &c. 

Others  are  indifferent  to  exposure,  sacrifice  comparative 
safety  to  convenience,  lay  during  the  very  dangerous  season  of 
the  year  at  wharves,  with  their  ship’s  company  going  any  and 
every  where  they  please,  and  say,  “Oh,  we  wdll  take  our 
chances;”  and  that  class  of  captains  are  ever  ready  to  deny  that 
they  have  had  or  have  now  any  sickness  aboard. 

The  key  to  the  sanitary  condition  of  the  port  of  Havana  in 
relation  to  infections  diseases  lies  largely  in  the  hospitals,  pub¬ 
lic  and  private,  of  which  there  are  eight  or  ten. 

Here  the  inspector  is  very  vigilant,  and  here  he  will  usually 
encounter  the  sick  from  vessels  and  can  learn  what  ships  they 
are  from,  &c.  Frequent  visits  are  made  to  these  institutions. 

From  what  has  been  stated  in  this  paper,  it  would  seem  that 
vessels  going  to  the  United  States  from  the  port  of  Havana 
can,  for  the  convenience  of  bills  of  health,  be  classified  into 
four  different  classes : 

The  first  class,  or  “good,”  would  include  those  vessels  which 
remain  in  the  open  bay,  keep  their  crews  aboard,  and,  in  short, 
observe  rigidly  all  the  methods  of  modern  maritime  sanitation. 
In  them  the  sanitary  history,  condition,  cargo,  crew  and  pas¬ 
sengers  are  all  marked  good.  Sailing  vessels  would  take  nei¬ 
ther  cargo,  ballast  or  passengers  from  Havana.  It  is  believed 
that  the  most  of  such  vessels  could  enter  ports  in  the  United 
States  at  any  season  without  imperilling  the  health  of  these 
ports. 

Second  class,  or  “fair,”  includes  such  vessels  as  do  not  go  to 
wharves,  neither  are  they  particular  about  the  use  of  disin¬ 
fectants  or  extreme  cleanliness.  These  may  go  to  wharves 


126* 

* 

during  winter  months,  in  which  case  they  disinfect  and  cleanse 
thoroughly. 

Third  class,  which  are  indicated  by  “fair  only,”  or  “a  little 
suspicious,”  are  those  vessels  which  go  to  wharves  but  have  not 
had  yellow  fever  aboard  in  consequence.  Fair  only,  or  a  little 
suspicious,  are  intended  to  be  synonymous  terms. 

Fourth  class — “suspicious,”  sometimes  “evidently  infected,” 
are  those  which  go  to  wharves  in  the  dangerous  season  which 
are  known  or  believed  to  be  infected — or  those  vessels  which, 
although  in  the  open  bay,  have  become  surrounded  by  infected 
vessels  from  the  wharf,  and  in  consequence  have  had  yellow 
fever  occur  among  their  crew ;  and  in  which  little  has  been 
done  to  remedy  their  insanitary  condition. 

There  is  every  reason  to  believe  that  many  vessels,  at  wharves, 
become  infected  in  fact,  particularly  Spanish  vessels,  which  do 
not  reveal  their  dangerous  condition  by  any  sickness  existing  or 
having  occurred  aboard,  as  their  entire  crews  have  immunity 
from  yellow  fever  by  having  had  it  before.  Other  vessels  on 
entering  the  harbor  immediately  discharge  all  unacclimated 
persons,  and  ship  new  ones  only  the  moment  they  desire  to 
leave.  In  such  cases  there  can  be  no  tell-tale  incident  to  betray 
their  actual  condition  in  regard  to  infection. 

It  is  found  that  the  statements  of  the  officers  and  crew  of 
the  average  sailing  vessel  are  so  unreliable  that  the  sanitary  his¬ 
tory  must  depend  to  a  great  extent  upon  the  vigilance  and  port 
experience  of  the  inspector  himself.  Captains  have  frequently 
declared,  that  they  had  had  no  sickness,  when  the  inspector 
knew  and  had  seen  some  of  their  men  sick  in  hospital  with 
yellow  fever,  and  again  confronted  them  aboard  convalescent, 
but  still  yellow  as  oranges. 

Instances  like  the  following  used  to  occur  much  oftener  than 
at  present : 

A  Spanish  steamer,  bound  for  New  Orleans,  applied  a  few 
years  ago  for  the  consular  bill  of  health,  presenting  that  of  the 
local  board,  in  which  it  was  stated  that  all  were  well  aboard  and 
that  there  was  no  disease  of  an  infectious  or  epidemic  character 
in  the  harbor.  I  knew  that  the  steamer  had  been  discharging 


127 


three  or  four  days  at  an  infected  wharf,  and  on  going  aboard 
to  inspect  crew  and  vessel,  I  found  the  chief  engineer  and  two 
men  down  with  yellow  fever.  The  engineer’s  case  was  a  rapid 
and  malignant  one,  for  he  was  already  vomiting  black  and  won¬ 
dering  what  it  was,  and  why  he  felt  so  weak  in  so  short  a  time. 
The  sick  were*  all  sent  ashore  and  the  engineer  died  the  next 
day.  Here  was  a  vessel  about  to  start  for.  Hew  Orleans,  with 
a  clean  bill  of  health  from  the  Cuban  or  local  board  of  health, 
while  three  of  her  crew  were  actually  sick  and  dying  of  yellow 
fever  aboard. 

The  unreliable  character  of  bills  of  health,  issuing  from  local 
boards  of  health  in  some  foreign  ports,  subject  to  all  the  influ¬ 
ences  of  social,  political  and  commercial  surroundings,  which 
consider  only  the  supposed  interest  of  their  own  place,  is  well 
shown  in  such  an  instance  as  has  just  been  narrated.  It  also  shows 
that  that  instrument,  to  be  of  protective  sanitary  value,  should  be 
made  out  by  one  who  not  only  keeps  himself  aucourant  with  the 
prevailing  diseases,  and  particularly  any  of  an  infective  charac¬ 
ter,  but  also  with  the  sanitary  condition  of  the  port  and  the  vessels 
therein.  He  also  should  be  one  whose  interests  and  sympathies 
are  with  the  people  of  the  port  of  destination,  who  has  a  natu¬ 
ral  and  loyal  desire  to  assist  in  protecting  them  from  the  intro¬ 
duction  of  infectious  and  contagious  diseases,  and  who  can  be 
held  responsible  to  those  who  appointed  him  and  to  the  country 
which  he  serves.  In  the  faithful  execution  of  his  mission,  he 
often  has  many  disagreeable  duties.  Where  is  the  sanitarian 
or  quarantine  official  who  at  times  is  not  criticised  most  un¬ 
justly  and  unmercifully,  and  calumniated  without  sense  or  rea¬ 
son  ?  Every  captain  wants  what  he  calls  a  clean  bill  of  health , 
no  matter  how  infected  the  city  and  wharves  and  his  vessel 
may  be.  The  sickness  may  have  occurred  aboard,  and  which 
may  have  resulted  in  death  from  yellow  fever  in  hospital  or 
elsewhere,  he  calls  a  bad  cold,  or  the  result  of  the  bad  care  the 
sailor  took  of  himself,  &c.,  or  anything  to  disguise  the  facts. 

The  sanitary  inspector  frankly,  in  the  consul’s  bill  of  health, 
tells  whether  in  his  opinion  the  sanitary  condition  of  the  port, 
and  vessel  particularly,  is  good — fair — a  little  suspicious — or 


128 


suspicious  and  infected,  and  thus  a  hint  is  given  to  the  authori¬ 
ties  at  the  port  of  arrival.  Notwithstanding  the  principal 
sources  of  danger  to  legitimate  shipping,  and  therefore  to  ports 
to  which  they  are  bound,  are  sufficiently  indicated  for  all  prac¬ 
tical  purposes.  Standing  as  I  do  as  a  kind  of  sanitary  lookout, 

I  cannot  close  this  paper,  already  perhaps  tiresome  in  detail, 
without  referring  to*  a  constant  source  of  peril  from  the  intro¬ 
duction  of  yellow  fever  into  the  States  of  the  South,  and 
particularly  Florida,  infinitely  greater  than  all  others  put  to¬ 
gether.  I  refer  to  that  kind  of  illicit  intercourse  which  is  car¬ 
ried  on  between  the  ports  of  Cuba,  principally  Havana  and 
Florida,  by  a  class  of  light-draught,  fast-sailing  vessels  which 
sail  from  there  in  quite  large  numbers.  These  have  for  their 
ostensible  and  legitimate  business,  fishing,  and  they  are  called 
viveros  or  fishing  smacks,  and  while  they  do  quite  a  fair  busi¬ 
ness  in  that  way,  they  often  do  a  more  paying  one  in  an  illegiti¬ 
mate  manner  by  smuggling  different  articles  into  the  country 
on  whose  coasts  they  hover  for  both  of  the  above  purposes. 

No  dirtier  or  worse  smelling  vessels  probably  leave  the  port  ’ 
of  Havana ;  their  inside  condition  and  atmosphere  being  emi¬ 
nently  favorable  for  the  reception  and  growth  of  such  disease 
germs  as  thrive  under  the  influence  of  heat,  moisture  and  filth. 
Laying,  as  many  of  them  do  while  here  (and  that  for  a  long 
time  frequently),  at  wharves  notoriously  dangerous,  with  an 
under  deposit  of  sewage  and  foecal  pollutions,  and  doubtless  in¬ 
fection,  every  opportunity  is  given  the  cause  of  yellow  fever 
to  get  aboard,  and  render  the  little  craft  a  vile  storehouse  of 
infectious  disease.  Moreover,  there  is  reason  to  believe  that 
young  men  recently  arrived  from  Spain,  and  totally  unaccli¬ 
mated,  are  at  times  shipped  as  some  of  the  crew. 

The  articles  which  this  class  of  vessels  can  smuggle  into 
Florida  and  Mexico  to  the  greatest  advantage  are  cigars, 
aguardiente  or  rum,  gin,  wine,  fruit,  etc.  The  inducement  to 
smuggle  aguardiente  and  rum  is  very  great,  as  the  spirit  which 
costs  only  twenty-five  or  thirty  cents  a  gallon  in  Havana,  pays 
a  duty  of  two  dollars  a  gallon  in  the  United  States. 

The  method  of  doing  these  two  branches  of  business,  viz : 


W  ; 


fishing  and  smuggling,  is  an  open  secret  at  Havana,  and  the 
fishing  fraternity,  when  they  have  a  little  confidence  in  the 
person  to  whom  they  are  talking,  say  very  frankly  that  it  is 
not  a  difficult  thing  at  all  to  smuggle  their  stuffs  into  Florida 
or  Mexico,  and  there  is  but  little  danger  in  it. 

These  vessels  clear,  or  rather  leave  port,  with  a  simple  permit 
to  go  out  and  fish  on  the  high  seas  or, along  the  coast.  Being 
small  of  size  and  resembling  coasters  they  go  out  at  any  time 
(usually  at  night),  but  no  one  knows  when  or  where  bound. 

Once  outside  of  the  Moro  Castle,  some  of  them  may  go  and 
fish  in  the  waters  up  about  Cardenas  and  Sagna,  others  to  the 
banks  of  Yucatan,  while  a  large  number  will  try  to  better  their 
fortunes  in  the  waters  and  inlets  of  Florida.  Some  of  those 
for  Florida  may  transfer  their  goods  to  Confederates  among 
that  line  of  keys  which  terminates  at  the  Tortugas,  while 
others  will  go  farther  up  and  hover  around  the  coast  of  the 
main  land,  all  the  way  from  Punta  Rossa,  Charlotte  Harbor, 
up  past  Tampa,  and  even  on  beyond  Cedar  Keys. 

Here  they  are  on  the  alert,  waiting  a  favorable  opportunity 
to  dispose  of  what  they  have,  either  to  confederates,  or  make 
an  unlawful  incursion  into  some  of  the  many  inlets,  bayous  and 
passes  on  that  coast.  Once  inside,  they  communicate  with  the 
people  or  settlements  they  may  know,  interchange  visits  and 
commodities,  friends  sleep  aboard,  articles  are  carried  ashore, 
and  it  is  feared  infective  disease  brought  in  with  them  from 
Havana. 

I  am  credibly  informed  of  these  methods,  and  that  many 
outside  of  fishing  and  smuggling  circles  know  of  them.  Cap¬ 
tains  of  steamers  running  along  the  coast  from  Charlotte 
Harbor  to  Tampa,  etc.,  tell  me  that  they  often  see  about  day¬ 
break  this  class  of  vessels  which  they  know  to  be  Spanish, 
coming  out  of  the  inlets,  bayous  and  passes.  They  have  no 
business  there  except  to  smuggle.  If  this  smuggling  was 
limited  to  articles  of  commerce  it  would  be  bad  enough,  but 
when  terrible  infective  disease  is  smuggled  into  the  midst  of  an 
unsuspecting  people  in  this  manner  it  is  in  the  highest  degree 
culpable. 


9 


130 


Florida,  with  an  extent  of  sea-coast  greater  than  that  of  any 
other  State  bordering  on  the  Atlantic  or  Gulf,  is  more  exposed 
by  these  smugglers  than  any  other  State  in  the  Union. 

A  condition  of  things  has  increased  this  illegal  business  very 
much  within  the  last  few  years.  Several  years  ago  Spain  put 
so  high  a  duty  on  the  importation  of  live  fish  from  the  States 
that  the  many  fishing  smacks,  which  up  to  that  time  had  been 
doing  a  nice  paying  live  fish  business  from  Key  West  and 
other  places  of  Florida,  were  obliged  to  suspend  business.  A 
large  portion  of  those  little  vessels  were  then  sold  to  live  fish 
merchants  in  Havana,  and  since  then  there  have  been  not  far 
from  fifty  of  these  light-draught,  fast-sailing  vessels  going  out 
of  the  harbor  of  Havana.  Being  nearly  all  built  in  the  United 
States,  in  American  waters  they  are  taken  for  American  vessels 
till  they  are  made  to  show  their  papers. 

During  that  period,  or  the  last  five  years,  a  large  and  rapidly 
increasing  population  has  appeared  in  Florida,  and  particularly 
on,  the  Gulf  coast,  which  requires  the  very  articles  to  be  found 
in  Havana. 

It  is  well  known  that  where  there  is  a  demand  for  an  article, 
the  article  is  very  sure  to  be  obtained  in  some  way,  either  by 
fair  or  foul  means. 

Finally,  I  would  say,  that  in  view  of  the  facts  stated,  and  as 
a  result  of  my  personal  observations  as  sanitary  inspector  at 
Havana,  I  am  decidedly  of  the  opinion  that  one  or  more  lines 
of  steamers  to  Florida  ports,  under  proper  sanitary  supervision, 
and  all  the  restrictions  mentioned  in  the  first  part  of  this  paper, 
whereby  danger  of  their  conveying  disease  is  reduced  to  a 
minimum,  will  do  much  to  suppress  this  illegal  traffic  by  trans¬ 
porting  the  articles  required. 

The  danger  of  introducing  infectious  disease  by  such  steamers 
is  so  small,  that  it  cannot  for  one  moment  be  compared  to  that 
infinitely  greater  one  by  the  smuggling  by  vessels  referred  to. 


APPENDIX  X. 


“THE  QUARANTINE  OF  THE  FUTURE” 

BY 

W.  C.  YANBIBBER,  M.  D., 
of  Baltimore,  Md. 


I  desire  to  enlist  your  interest  in  the  design  of  an  estab¬ 
lishment  for  the  promotion  of  health  and  the  suppression 
of  disease.  I  can  not  doubt  that  similar  ideas  may  have 
occurred  to  many  of  you;  but  as  I  have  given  the  matter 
much  and  careful  consideration,  and  have  thoughtfully 
weighed  all  the  points  that  presented  themselves  to  my 
mind,  I  have  the  temerity  to  suppose  that  the  design  I 
shall  suggest  will  probably  be  more  complete  in  detail  than 
any  that  has  been  proposed.  At  least,  I  am  safe  in  saying 
that  no  such  system  has  yet  been  put  into  operation  in  this 
country,  even  in  those  localities  where  something  of  the 
sort  is  most  urgently  demanded.  I  will  call  my  design,  for 
the  present,  a  system  of  quarantine,  as  its  first  object  is  to 
prevent  the  introduction  and  spread  of  communicable  dis¬ 
ease  ;  but  I  energetically  protest  against  my  views  suffering 
prejudice  by  reason  of  the  repellent  associations  which  are 
too  often — and  often  too  justly — connected  with  that  name. 
As  the*  hospital  of  to-day  is  something  very  different  from 
the  “lazaretto”  or  lepers’  house  of  the  middle  ages,  so  the 
quarantine  of  the  future  must  be  something  different  from 
the  inefficient,  and  at  best  unattractive,  quarantine  of  to-day. 
I  will  call  it  the  “State  Bureau  of  Health  and  Quarantine,” 
and  look  forward  to  a  system  which  will  be  not  only  scien¬ 
tific  and  effectual,  but  attractive  ;  so  that  those  for  whom  it 
is  provided,  whether  for  personal  treatment  or  for  public 


132 


safety,  will  rather  be  lured  to  it  than  repelled  ;  and  the  sick 
gladly  avail  themselves  of  its  beneficent  arrangements.  I 
look  forward  to  an  establishment  worthy  of  the  State  which 
founds  it,  and  a  pride  to  her  citizens.  If  such  a  result  be 
desirable — which  I  think  will  hardly  be  questioned — and  if 
the  design  which  I  shall  broach  promises  to  realize  such  a 
result — of  which  you  must  be  the  judges — may  I  not  appeal 
to  my  professional  brethren  to  come  forward  as  pioneers  in 
this  movement ;  to  give  the  light  of  their  experience  and 
wisdom  in  perfecting  what  may  be  left  imperfect,  and  the 
weight  of  their  influence  in  disseminating  enlightened  ideas, 
and  combatting  old  prejudices?  It  lies  with  them  to  ex¬ 
plain  to  the  public  what  a  well-equipped  and  scientific  quar¬ 
antine  system  ought  to  be,  and  may  be ;  and  how 
thoroughly  physicians,  if  their  exertions  are  sup¬ 
ported  by  wise  laws  and  seconded  by  public 
opinion,  can  now  cope  with  those  communicable 
diseases  which  are  so  often,  and  have  been  so  recently, 
causes  of  wide-spread  suffering  and  of  the  wildest  terror. 
There  is  an  old  saying  that  “afflictions  are  often  blessings 
in  disguise.”  Though  in  no  case,  perhaps,  is  the  disguise 
thicker  and  harder  to  penetrate,  than  in  that  of  a  grt?at  ep¬ 
idemic,  yet  even  here  it  lies  with  us  to  make  the  proverb 
good,  if  the  effective  epidemic  leads  us  to  devise  means 
against  its  recurrence.  Certainly  it  is  a  discredit  to  our 
civilization,  to  our  humanity,  and  almost  a  reproach  to  the 
noble  profession  to  which  we  have  devoted  our  lives,  that 
such  diseases  should  paralyze  whole  communities,  and  drive 
them  into  paroxysms  of  frantic  terror.  Eecent  advances 
which  have  been  made  in  the  study  of  the  quarantined  dis¬ 
eases,  will  permit  some  things  to  be  done  now  with  safety, 
which  were  not  formerly  allowed. 

Formerly,  if  a  community  proposed«to  place  a  quarantine 
establishment  in  an  accessible,  convenient  and  desirable 
situation,  such  opposition  would  be  made,  and  such  influ- 
ences  brought  to  bear,  that  the  site  would  have  to  be  aban¬ 
doned,  and  the  buildings,  necessarily  located  in  some  un- 


133 


attractive,  inconvenient  and  perhaps  unhealthy  place — 
turned  out  into  the  wilderness  like  the  scape-goat,  and  pur¬ 
sued  even  there  by  the  fears  and  aversion  of  the  whole 
community.  All  this  is,  or  should  be,  a  by-gone  state  of 
*  things.  In  the  city  in  which  I  live — Baltimore — when 
more  than  sixteen  years  ago,  the  late  John  Hopkins 
bought  thirteen  acres  of  land  within  the  city  limits  and 
proposed  to  build  thereon  a  public  hospital,  there  arose 
strong  opposition  on  the  ground  of  prejudice  and  the  dread 
of  spreading  disease  ;  but  now  that  the  noble  foundation, 
which  bears  his  name  is  erected,  none  of  this  feeling  exists. 

Our  people  are  logical,  and  it  did  not  take  long  for  the 
objectors  to  see  that  the  function  of  a  hospital  is  to  extin¬ 
guish  disease,  not  to  spread  it  ;  and  that  communicable  dis¬ 
eases  are  far  less  dangerous  to  the  community  when  con¬ 
fined  under  the  immediate  control  and  supervision  of  a 
corps  of  physicians  and  nurses,  who  may  be  able  to  steril¬ 
ize  the  germs  emanating  from  infected  patients,  than  if 
these  latter  were  allowed  to  scatter  themselves  throughout 
the  community,  and  become  FOCI  of  infection  at  many 
points.  The  fact  is,  it  is  only  necessary  for  the  people  to 
understand  how  different,  the  well  appointed  scientific  hos¬ 
pital  of  the  present  day,  is  from  the  traditional  hospital  of 
the  past,  and  their  views  and  prejudices  would  undergo  a 
radical  change.  Let  me  state  what  I  think  would  be  the 
public  feeling  here,  where  we  now  are,  if  such  a  question 
should  arise.  Should  the  State  of  Alabama  propose  to 
erect  a  quarantine  establishment  in  the  city  of  Montgom- 
,  •  ery,  and  set  about  securing  land  . for  the  purpose,  opposi¬ 
tion  might  at  first  be  raised  by  adjacent  property-holders  ; 
but  it  would  subside  as  soon  as  it  was  known  what  the  hos¬ 
pital  was  going  to  be.  *A  properly  built  and  appointed  hos¬ 
pital  is  an  embellishment  to  the  city  that  contains  it.  Its 
buildings  are  imposing,  its  grounds  are  spacious,  ornamen¬ 
tal  and  well  kept,  and  have  the  beauty  and  advantages  of  a 
public  park.  The  establishment  becomes  one  of  the  at¬ 
tractions  of  the  city,  and  neighboring  property  is  enhanced 


134 


in  value.  Those  of  you  who  have  seen  the  Johns  Hopkins 
hospital,  to  which  Baltimoreans  always  take  guests  from 
abroad,  as  one  of  the  chief  attractions  of  the  city,  can  bear 
out  what  I  say.  Now  if  proper  ideas  can  be  disseminated 
on  this  matter,  if  the  people  can  be  convinced  that  a  quar¬ 
antine  can  be  made  safe,  efficacious  and  at  the  same  time 
attractive,  that  it  will  effectually  prevent  not  only  the 
spreading  of  disease,  but  the  spreading  of  panic ,  such  a 
quarantine  will  certainly  enlist  in  its  favor  the  whole  body 
of  public  sentiment.  But  to  attain  this  desirable  end,  the 
community  must  be  enlightened  as  to  the  results  which 
have  followed  the  study  of  quarantined  diseases,  and  the 
use  of  sterilizing  agents  in  combatting  them,  of  which  we 
have  learned  much  of  great  value  from  Dr.  Wilkinson’s  pa¬ 
per. 

The  diseases  now  quarantined  in  this  country — I  need 
not  speak  of  such  rare  and  exceptional  cases  as  Asiatic-lep- 
rosy — are  three ;  small-pox,  cholera,  and  yellow  fever. 
What  physician  is  there  who  has  any  dread  of  small-pox  in 
his  own  person,  or  for  his  immediate  family  or  his  obedi¬ 
ent  patients  ?  The  physicians  and  people  of  England  have 
nearly  convinced  the  world  that  the  spread  of  cholera  may 
be  checked  by  sanitary  measures  ;  and  if  that  disease  spreads 
through  a  community,  it  is  the  fault  of  the  people.  I  say 
this  on  the  authority  of  one  who  is  with  us  now,  Surgeon 
George  H.  Sternberg  of  the  U.  S.  Army.  It  only  remains, 
then,  to  speak  of  yellow  fever. 

Less  careful  and  less  advanced  people  than  we  are,  living 
near  our  own  coasts,  bring  this  disease  to  us.  It  comes 
from  Hayti,  Cuba  and  Mexico. 

We  know  many  of  its  ways  and  peculiarities.  It  has  nev¬ 
er  yet  gained  a  permanent  abode  in  crur  country.  I  say  this 
on  the  authority  of  Dr.  Cochran  and  Dr.  Wall,  as  also  of 
other  physicians  in  New  Orleans,  though  I  admit  that  Sur¬ 
geon  General. Guiteras,  U.  S.  M.  H.  S.,  from  some  recent 
investigations  in  Key  West,  is  not  so  sure  on  this  point. 
Be  this  as  it  may,  it  is  the  clear  and  urgent  duty  of  us 


135 


Americans  to  prevent  the  introduction  or  the  domestication 
of  this  pest-germ  on  our  soil  if  we  can.  The  several  states 
and  the  Federal  Government  are  alike  interested  in  this 
matter.  The  germ  has  been  most  frequently  brought  into 
Louisiana,  Texas,  Alabama,  Georgia,  and  the  two 
Carolinas.  But  it  has  also  been  brought  into  Vir¬ 
ginia,  Maryland,  Pennsylvania  and  New  York ;  conse- 
3  quently  all  the  states  in  the  Union  have  a  common  interest 
in  excluding  this  germ  and  this  disease.  This  convention  has 
assembled  here  to  consider  this  subject.  How  do  you  pro¬ 
pose  to  advise  those  governments  to  make  this  attempt  ? 
It  is  not  without  preparation  that  I  appear  before  you, 
gentlemen,  and  give  my  humble  advice  in  this  important 
*and  much  debated  matter.  With  the  knowledge,  and  all 
the  facilities  now  at  hand,  an  establishment  may  be  erected 
which  will  in  time  become  the  centre  of  study,  for  informa¬ 
tion  and  of  authority  upon  these  points ;  and  as  soon  as 
built  and  equipped,  will  be  a  school,  an  asylum  for  patients, 
a  place  for  isolation  and  for  controlling  communicable 
diseases  by  subduing  the  germ.  The  drawing  shows  the 
plan  of  such  an  establishment  designed  with  the  view  of 
fulfilling  these  purposes.  I  will  explain  it  more  in  detail 
later.  It  consists,  as  you  perceive,  of  four  buildings,  kept 
well  apart;  a  separate  hospital  for  each  of  the  quarantined 
diseases,  and  a  building  for  the  administration.  These  four 
buildings  are  connected  with  all  parts  of  the  State  by  rail¬ 
roads  and  telegraphs,  and  with  each  other  by  railways,  tele¬ 
graphs,  telephones,  and  electrical  transits.  It  is  intended 
«  that  the  spacious  grounds  shall  be  laid  out  as  a  park ;  por¬ 

tions  being  reserved  for  the  exercise  and  recreation  of  con¬ 
valescents,  and  other  portions  for  those  persons  who  come 
♦  from  an  infected  locality  ;  but  exhibit  no  symptoms  of  the 

disease ;  and  who,  of  course,  are  most  likely  to  be  impatient 
under  detention.  Quarters  should  be  provided  for  these  in 
the  main  building,  and  every  practicable  arrangement  made 
to  render  their  sojourn  as  pleasant  as  possible.  The  whole 
establishment  should  be  located  in  as  attractive  and  heal- 


136 


fill  site  as  possible ;  and  given  as  much  the  air  of  a  summer 
health  resort,  as  may  be  consistent  with  the  purposes  for 
which  it  is  destined. 

The  main  building  would  be  the  place  at  which  all  infor¬ 
mation  should  be  centered,  and  from  which  all  authority 
should  emanate.  Here  would  be  the  headquarters  of  the 
medical  staff;  and  here  the  knowledge  acquired  at  the  bed¬ 
side  would  bear  its  fruits.  Here  should  be  kept  models  and 
designs  for  building ;  here  should  be  exhibited  the  highest 
standard  of  cleanliness ;  here  should  be  formulated  the 
sanitary  rules.  Each  subsidiary  department  should  be 
complete  in  itself.  The  small-pox  department  should  un^ 
dertake  to  keep  on  hand  thoroughly  reliable  vaccine  virus, 
and  distribute  it  throughout  the  state.  The  working  of 
such  an  establishment  would  be  something  like  this  :  on  the 
appearance  of  quarantinable  disease  any  where,  or  the 
landing  of  passengers  from  an  infected  locality,  the  staff 
would  be  immediately  communicated  with.  At  once  officers 
would  be  dispatched  to  remove  the  infected  or  suspicious 
persons,  to  investigate  the  circumstances  thoroughly,  and 
take  all  necessary  measures.  The  very  presence  of  these 
officers,  and  the  knowledge  that  the  matter  was  being 
promptly  and  efficiently  dealt  with,  would  quiet  alarm.  If 
I  may  use  a  trivial  comparison,  it  would  resemble  the  in¬ 
troduction  of  the  modern  fire  department  in  to  a  great  city. 
I  can  remember  when  Baltimore,  New  York  and  Philadel¬ 
phia  were  protected  only  by  volunteer  fire  companies  with 
hand  apparatus ;  these  firemen  were  brave  and  devoted 
men ;  but  there  was  no  proper  organization,  no  discipline, 
no  efficient  appliances.  They  worked  at  random,  and  there¬ 
fore  at  a  great  disadvantage.  Any  one  who  chose  might 
offer  his  advice  or  his  services,  and  this  well  meant  zeal  was 
often  a  hindrance  rather  than  a  help.  The  consequence  was 
that  a  large  fire  spread  alarm  over  the  city.  Now  that  we 
have  a  thoroughly  organized  department,  with  experienced 
chiefs,  improved  apparatus,  and  thorough  drill,  the  fire 
alarm  scarcely  causes  a  ripple  of  excitemei  Every  one 


i 


137 


knows  that  whatever  can  be  done,  will  be  done,  and  that 
the  whole  business  is  in  the  hands  most  competent  to 
manage  it.  The  practical  advantages  of  such  a  system  as 
I  have  described  may  be  summed  up  as  follows :  1.  It 

j  would  prevent  panics.  For  nothing  could  be  more  necessary 
to  a  community  than  the  knowledge  that  there  was  such  a 
body  of  men,  at  all  times  ready  to  meet  the  first  appearance 
t  of  disease,  and  thoroughly  provided  with  the  means  to  cope 
with  it.  2.  It  would  give  the  greatest  facility  for  preventing 
the  outbreak  of  an  epidemic,  and  subduing  the  germ  if  it 
made  its  appearance.  3.  It  would  give  the  best  possible 
facility  for  the  recovery  of  patients  attacked,  by  combining 
the  most  effective  medical  treatment  with  the  most  perfect 
possible  sanitation.  4.  It  would  be  a  headquarters  for  all 
movements  in  the  direction  of  hygiene  and  sanitation,  whether 
these  should  take  the  form  of  warning,  or  instruction  to  the 
people,  suggestions  to  medical  practioners  or  recommendations 
for  legislation.  5.  Each  of  these  establishments  would  be  in 
communication  with  other  similar  establishments  in  this  coun¬ 
try  or  the  world,  that  whatever  advance  was  made,  or  knowl¬ 
edge  acquired  at  the  one,  would  at  once  inure  to  the  benefit  of 
all.  Thus  each  would  possess  at  once  the  highest  possible  au¬ 
thority  ;  and  would  be  a  school  at  which  medical  practioners 
could  learn  the  latest  results  of  science  in  every  branch  that 
came  within  its  scope.  Such  an  establishment  should  be  built 
upon  a  large  domain ;  and  this  domain  might  at  the  same  time 
serve  for  other  useful  public  purposes.  Here  might  be  medi¬ 
cal  or  other  scientific  colleges  and  museums ;  a  vaccine  virus 
,  farm,  an  agricultural  college.  The  domain,  if  near  a  city, 

might  be  a  suburban  park. 

So  far  as  I  can  judge  there  is  more  knowledge  now  exist- 
*  ing  among  the  medical  officers  of  the  United  States  concerning 
this  branch  of  public  necessity,  than  can  be  found  elsewhere. 
Any  one  who  doubts  this  need  only  visit  the  war,  navy  and 
hospital  department  in  Washington,  where  he  can  judge  for 
himself.  I  am  not  thoroughly  acquainted  with  what  has  been 
done  by  other  governments  in  the  way  of  collecting  informa- 


138 


tion  bearing  on  that  branch  of  the  public  safety  which  relates 
to  communicable  diseases,  but  from  conversations  with  our 
.officers,  I  have  reason  to  think  that,  in  unapplied  knowledge, 
at  least,  we  are  in  the  advance.  It  is  therefore  eminently  fitting 
that  the  federal  government  should  utilize  these  collected 
treasures  of  knowledge,  and  show  the  work — the  needed  quaran 
tine  of  the  future.  It  seems  to  me  that  this  might  best  be  done- 
iffi Florida;  a  state  perhaps  more  dependent  at  present  on  her 
sister  states,  than  the  others,  and  important  as  a  winter  resort 
and  refuge  for  the  inhabitants  of  more  vigorous  climates.  If 
by  means  of  such  a  system,  Florida  was  always  and  certainly 
safe  for  visitors  when  the  northern  cold  began  to  be  trying  to 
persons  of  delicate  health,  or  sufferers  from  pulmonary  affec¬ 
tions,  the  advantage  and  the  blessing  would  be  incalculable.  I 
believe  that  this  matter  could  be  so  presented  to  congress  as  to 
enlist  the  favorable  consideration  of  that  body ;  but  in  this 
matter  I  can  only  offer  suggestions,  leaving  choice  of  steps  to 
the  judgment  of  others.  I  will  now  explain  the  details  of  the 
drawing. 

Note — in  this  drawing  the  architect  has  also  shown 
how  a  healthy  house  may  be  built  in  a  warm  climate,  standing 

upon  piers,  with  a  clear  story  above,  and  a  garden  roof.  I  am 
aware  of  an  objection  that  may  be  raised  to  my  plan.  It  may 
be  said  that  if  it  succeeds — if  communicable  diseases  be 
stamped  out  or  reduced  to  minimum,  our  staff  of  trained 
physicians  and  assistants  will  have  nothing  to  do.  We  can  not 
scatter  them  to  the  four  winds  and  put  the  buildings  in  charge 
of  care-takers,  and  hope  to  find  every  man  at  his  post  again 
if  disease  should  break  out.  I  answer  that  I  would  make  the 
institution  the  permanent  centre  of  hygiene  for  the  whole  state. 
How  hygiene  and  sanitation  never  rest ;  they  are  always  furn¬ 
ishing  new  occasions  for  deliberation,  investigation  and  action. 
Sudden  outbreaks  of  typhoid  fever,  of  diphtheria,  of  the  more 
malignant  types  of  zymotic  disease,  can  often  be  traced  to  local 
or  preventable  causes. 

In  such  cases  as  these — and  they  are  constantly  occurring — 
our  staff  would  be  called  upon.  Many  other  cases  will  occur 


139 


to  yon,  which  I  need  not  suggest.  I  think  that  in  denominat¬ 
ing  the  institution  a  state  bureau  of  health  and  hygiene,  I  meet 
the  objection  fully.  Besides  preventing  panics,  and  giving* 
eveiy  possible  chance  for  subduing  and  curing  the  disease,  this 
advanced  and  elevated  treatment  of  it,  will  have  a  tendency  to 
change  or  reduce  its  management  from  a  rough  and  pestiferous 
detention,  to  an  enlightened  and  agreeable  attendance  upon 
the  laws  of  the  ^treatment  and  prevention  of  disease. 
This  change,  I  think,  is  due  alike  to  the  unfortunate  patients 
themselves,  as  well  as  it  is  the  best  policy  for  the  public. 
From  conversation  with  some  of  our  statesmen,  it  is  my  belief, 
that  congress  could  be  interested  in  this  national  matter,  but  I 
must  leave  the  rest,  my  brethern,  with  you,  to  take  what  action 
you  may  wish,  to  bring  about  this  desired  result. 


Note. — The  plan  for  the  buildings  has  been  omitted. 


APPENDIX  XI. 


A  PLEA  FOR  YELLOW  FEVER  INOCULATION  AS 
A  PROPHYLACTIC  MEASURE, 

BY 

DR.  J.  McF.  GASTON, 
of  Atlanta. 


As  germane  to  the  object  of  this  Conference  for  the  preven¬ 
tion  of  yellow  fever,  it  seems  proper  to  consider  the  claims  of 
a  prophylactic  measure  which,  if  it  effects  anything,  is  to  be 
regarded  as  the  most  radical  means  of  preventing  the  access  of 
yellow  fever.  I  refer  to  inoculation  with  the  attenuated  virus 
of  yellow  fever.  It  is  known  to  me  that  there  are  distinguished 
gentlemen  present  who  differ  from  my  view  of  this  measure, 
yet  I  trust  they  may  aid  in  the  elucidation  of  this  subject. 

I  would  state  that  previous  to  the  past  six  years,  my  resi¬ 
dence  in  Brazil  for  a  long  period,  enables  me  to  act  under¬ 
standing^  in  this  matter,  and  my  only  interest  is  for  the 
general  good. 

From  Dr.  Sternberg’s  instructive  and  interesting  description 
of  the  observations  made  by  himself  and  others,  it  is  inferred 
that  the  germs  or  bacteria  presented  by  Freire,  Carmona,  Gibier, 
Finlay  and  others,  are  not  to  be  regarded  as  identified  uni¬ 
formly  in  connection  with  yellow  fever,  so  that  the  yellow 
fever  bacillus  has  yet  to  be  discovered.  It  is  most  probable 
that  the  views  of  Dr.  Vaughan  in  regard  to  certain  diseases  be¬ 
ing  developed  by  ptomaines  after  the  death  of  bacteria  in  the 
different  structures,  may  be  the  key  to  explain  the  phenomena 
of  yellow  fever.  All  are  aware  that  in  the  case  of  hydatids, 


141 


the  chief  element  of  disorder  is  their  death,  and  hence  it  would 
seem  that  the  most  philosophic  investigation  after  the  pro¬ 
gressive  changes  in  yellow  fever  have  resulted  fatally,  should 
not  detect  living  bacteria  in  the  structures  of  the  body,  but 
that  they  should  be  sought  in  the  fluids  or  secretions  of  the 
subject  of  yellow  fever  in  its  early  stages. 

Independent  altogether  of  the  recognition  of  a  special  ba¬ 
cillus  of  yellow  fever,  there  is  a  practical  question  of  prime 
importance  in  regard  to  the  feasibility  of  protection  by  any 
process  of  inoculation  or  vaccination,  such  as  proves  effectual 
against  the  small  pox. 

When  Jenner  introduced  vaccination  nearly  a  century  ago, 
the  presumption  against  his  process  was  stronger  than  that 
which  exists  at  the  present  day  against  yellow  fever  inocula¬ 
tion,  and  it  was  necessary  to  determine  by  actual  demonstra¬ 
tion  that  the  modified  impression  produced  by  vaccination 
really  gave  immunity  from  any  serious  effects  of  variola. 

This  is  the  course  which  must  be  pursued  with  respect  to 
inoculation  against  yellow  fever. 

Facts  are  stubborn  things,  and,  as  in  medicine  we  use  many 
remedies  emperically  without  having  any  rational  explanation 
of  their  modus  operand i,  we  are  called  upon  to  test  the  pro¬ 
phylactic  virtues  of  yellow  fever  inoculation  without  having  a 
truly  scientific  clue  to  its  efficacy. 

If  it  appears  that  inoculation  in  any  form  or  with  any  sub¬ 
stance,  be  it  a  bacillus  or  not,  prevents  or  modifies  the  pro¬ 
gress  of  yellow  fever  in  human  beings,  we  are  warranted  in 
resorting  to  it  to  secure  our  people  against  the  ravages  of  this 
disease. 

It  is  claimed  that  such  a  process  has  been  employed  with 
satisfactory  results  in  Rio  de  Janeiro  by  Dr  Domingo  Freire, 
and  the  results  have  been  tabulated,  giving  the  names  and 
location  of  those  inoculated,  reaching  above  seven  thousand  in¬ 
dividuals,  subject  to  the  scrutiny  of  interested  observers.  The 
deaths  among  all  those  subjected  to  this  process  have  not  ex¬ 
ceeded  one  to  the  thousand,  while  the  percentage  of  deaths 
among  those  attacked  with  yellow  fever  in  the  same  localities 


142 


has  far  exceeded  this  proportion,  being  one  in  one  hundred. 
Under  such  circumstances  we  must  either  disprove  the  sta¬ 
tistics  or  accept  the  results  as  conclusive  in  favor  of  inocula¬ 
tion  by  the  attenuated  virus  of  yellow  fever. 

A  thorough  examination  of  the  data  by  a  competent  com¬ 
mission  of  practical  observers  prepared  to  discriminate  between 
the  true  and  the  false,  is  the  only  available  mode  of  testing 
this  matter,  and  while  scientific  investigation  should  prove 
many  points  of  great  interest,  there  are  elements  of  common 
sense  requisite  to  reach  correct  conclusions  by  the  members  of 
this  commission. 

In  view  of  the  fact  that  inoculation  with  the  attenuated 
virus  of  yellow  fever  has  been  used  as  a  prophylactic  measure, 
and  in  consideration  of  the  action  taken  by  the  American 
Health  Association  and  the  American  Medical  Association 
recommending  the  appointment  of  three  commissioners  for  the 
investigation  of  this  subject,  while  the  United  States  Govern¬ 
ment  only  authorized  one  commissioner  to  vis*'  Frezil  and 
Mexico  in  furtherance  of  this  proposition,  it  ’  the  sense  of 
this  Convention  that  the  object  intended  by  the  said  Associa¬ 
tion  has  not  been  satisfactorily  met  or  complied  with. 

Furthermore,  it  is  worthy  of  note  that  favor;. ble  action  was 
taken  by  the  International  Medical  Congress,  in  recommend¬ 
ing  the  investigation  of  yellow  fever  inoculation  ;  and  in  con¬ 
sideration  of  these  facts — 

Be  it  resolved ,  That  inoculation  with  the  attenuated  virus  of  yellow 
fever  for  the  modification  or  prevention  of  this  disease,  calls  for  thorough 
examination,  and  that  the  statistics  should  receive  careful  and  dis¬ 
criminating  investigation  by  practical  observ  ;is  for  the  verification  of 
the  data  presented. 

Bf.  it  further  resolved ,  That  this  Convention  acquiesces  in  the  recom¬ 
mendation  of  the  above  named  associations  1  at  three  commissioners 
be  appointed  by  the  United  States  Governmei  t  for  a  full  investigation 
of  the  claims  of  the  prophylactic  virtues  of  inoculation  against  yellow 
fever. 


APPENDIX  XII. 


SPECTROSCOPIC  EXAMINATION  OF  BLACK 

YOMIT, 

BY 

Dr.  GEO.  T.  KEMP, 

Of  Hoa  gland  Laboratory. 


Brooklyn,  N.  Y.,  March  4,  1889. 

My  Dear  Doctor :  After  your  departure,  I  opened  the  bottles 
containing  the  black  vomit  collected  by  you  last  J une.  The 
vomit  was  much  decomposed,  but  in  spite  of  this  decomposition 
the  masses  of  partly  decolorized  red  blood  corpuscles  could  still 
be  made  out.  A  spectroscopical  examination  proved  the  exist¬ 
ence  of  blood  pigment  beyond  a  shadow  of  doubt !  The  reac¬ 
tion  of  the  vomit  was  strongly  alkaline  from  fermentation,  and 
the  vomit,  untouched  by  any  chemical  reagent,  gave  the  spec¬ 
trum  of  alkaline  hcematin.  Boiling  this  with  acetic  acid  gave 
the  spectrum  of  acid  hcematin ,  and  treating  the  vomit  with 
Stokes’  fluid  and  ammonia  gave  the  characteristic  beautiful 
bands  of  Hsemochromogen,  (Stokes’  Reduced  Hsematin). 
These  are  the  characteristic  spectra  which  one  would  expect  to 
obtain  from  decomposed  blood,  and  prove,  beyond  all  question, 
the  presence  of  blood  pigment  in  the  vomit. 

These  obsevations  agree  with  those  of  Dantec,  except  in  one 
point,  viz:  that  he  found  the  pigment  in  the  condition  of  hcema- 
globin  or  methsemaglobin.  There  is  not  the  slightest  contra¬ 
diction  here,  for  he  examined  the  vomit  fresh,  while  the  speci¬ 
mens  at  my  disposal  had  undergone  alkaline  decomposition,  and 
this  process  should  change  the  hsemaglobun  or  methsemaglobin 


found  by  him,  into  the  alkaline  liaematin  found  by  me.  Our 
observations,  therefore,  are  entirely  in  accord.  I  only  exam¬ 
ined  the  specimens  taken  from  the  stomach /  the  specimens  of 
dark  colored  material  from  the  intestine,  I  shall  examine  later. 


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